Over three years, Medicare Shared Savings Program ACOs saved a gross $1.8 billion, nearly twice as much as the amount CMS has reported, according to a NAACOS-commissioned report. The difference is not in the data itself but how it's analyzed.
The way the government has been analyzing performance data for accountable care organizations in the largest value-based payment model in the country severely underemphasizes the amount of money these ACOs are saving, according to a report released Tuesday.
Since most of the ACOs currently in the Medicare Shared Savings Program (MSSP) are in tracks without downside risk, the findings are poised to fuel debate over the Centers for Medicare & Medicaid Services' plan to require downside risk sooner—part of an overhaul that's projected to reduce the number of MSSP ACOs by nearly 20% over the coming decade.
The study, which was commissioned by the National Association of ACOs (NAACOS) and conducted by the healthcare consulting firm Dobson DaVanzo & Associates, found that MSSP ACOs generated estimated gross savings of $1.84 billion during performance years 2013 through 2015. That's nearly double the $954 million in estimated gross savings CMS had reported.
The report doesn't accuse CMS of fudging the numbers; rather, it attributes the discrepancy to differences in methodology. Instead of relying on the same benchmarking CMS uses to establish ACO targets and calculate penalties or bonuses, the report tabulated MSSP ACO savings using difference-in-differences regression analysis, which it described as "the gold standard for program evaluation."
After accounting for bonuses paid to high-performing ACOs, the NAACOS-backed report estimated MSSP generated net savings of $541.7 million to the federal government for 2013-2015. The CMS benchmarking methodology, by contrast, tabulated a net loss of $344.2 million.
NAACOS President and CEO Clif Gaus, ScD, said the report should "put to rest" any assertion that upside-only ACOs have failed to save Medicare money.
"The findings confirm the wisdom of giving ACOs adequate time to build the care coordination, information technology, and data analytics capabilities needed to manage financial risk successfully," Gaus said in a statement Tuesday morning.
'Gold Standard' Precedent
When CMS announced with fanfare last month that the inaugural cohort of 18 Next Generation ACOs had saved $62 million in their first year of operation, Administrator Seema Verma cited the results as "further evidence that ACOs succeed under two-sided risk." The data seem to buttress her support for hastening downside risk under the agency's proposed MSSP ACO overhaul.
Gaus applauded the agency's use of "the gold standard" difference-in-differences analysis, saying it clearly demonstrated the Next Generation ACO model's success. But, foreshadowing Tuesday's report, he also suggested CMS would find "billions of dollars" in savings if it conducted a comparable analysis for MSSP ACO savings using the same standard.
When asked by HealthLeaders why CMS hadn't conducted the same analyses on both ACO models, an agency press representative noted that MSSP, which was established by statute, has different evaluation requirements than do models tested by the CMS Innovation Center.
Those differing requirements could explain why MSSP ACOs haven't received the same analysis as their Next Generation counterparts, says Aledade founder and CEO Farzad Mostashari, MD, a former National Coordinator for Health Information Technology.
"It's an explanation, but it's not really a reason," Mostashari tells HealthLeaders. "I do agree that they should consider certainly the full benefits of the program when making policy decisions."
At the same time, Mostashari says the NAACOS-backed report doesn't seem to be saying anything with which CMS actuaries would substantively disagree. The agency has acknowledged in its own regulatory impact assessment that benchmarks are underestimating MSSP savings.
"Given this fact, what are the policy implications of that?" he adds.
Joe Damore, vice president of population health for Premier, said in a statement that the report's findings provide a significantly more accurate picture of the impact MSSP ACOs are having.
"We agree that measuring program savings against a benchmark of potential spending is a flawed way to assess true impact," Damore said. "The measure should not be whether spending was reduced relative to a national target that does not take into account regional costs and patient acuity over the contract period, but rather whether ACOs generated any savings for Medicare over and above historic [fee-for-service] spending for the ACO's beneficiaries."
Policy Recommendations
To coincide with the release of Tuesday's report, Gaus penned a Health Affairs blog post with Robert E. Mechanic, executive director of the Institute for Accountable Care, outlining three suggested changes to the proposed MSSP ACO overhaul:
Don't cut the shared savings rate in half. Currently, MSSP ACOs that hit their targets split the savings 50/50 with Medicare. The proposed rule for 2019 would cut that shared savings rate in half, to 25% in the initial year for the new upside-only track. Gaus and Mechanic said the 50% rate should stay.
Allow new ACOs to linger in upside-only tracks for at least three years. Organizations that meet certain savings and quality goals could add another two years without downside risk under Gaus and Mechanic's suggestion. (The current cap for upside-only MSSP ACOs is six years, and CMS has proposed cutting that timeline to two years.)
Allow the beneficiary risk score to vary a bit more. The CMS proposal calls for an aggregate 3% limit over five years in changes to beneficiary risk scores. Gaus and Mechanic contend that limit should be loosened to 5% over the five-year enrollment period.
"We agree with the administration that ACOs need to evolve and take on more financial risk, but the administration's own estimates suggest that rather than growing, the Medicare ACO program would shrink by 20 percent over the next decade under its proposed rule. That would be a tragedy," Gaus and Mechanic wrote in the Health Affairs blog. "The changes we propose would go a long way towards improving incentives for growth of Medicare ACOs, while achieving the administration's goal of a faster movement to risk."
Editor's note: This story was updated to include a statement from Premier.
The for-profit hospital operator's current president and COO will take over as CEO, and the son of HCA's founder is expected to be named its next chairman.
Nashville-based HCA Healthcare announced Monday morning that Chairman and CEO R. Milton Johnson will retire at the end of the year, completing exactly five years as the company's top executive.
Johnson, who has worked 36 years for the for-profit hospital operator, will be succeeded as CEO on January 1 by current HCA President and Chief Operating Officer Sam Hazen, the board of directors said.
Johnson will retain his title as HCA chairman through the company's annual shareholders meeting on April 26, at which point the directors plan to appoint current board member Thomas F. Frist III as chairman.
"I remain excited about the company’s future and have strongly endorsed Sam as the right person to lead the company; his leadership has greatly contributed to our success," Johnson said in a statement.
Left to right: R. Milton Johnson, Sam Hazen, and Thomas F. Frist III (HCA)
Hazen, who has worked for HCA nearly as long as Johnson has, served previously as HCA's COO, its president of operations, Western Group president and Wester Group chief financial officer, the company said.
"I want to thank Milton for his strong leadership during his many years with the company," Hazen said in the statement.
"In this transition and beyond, I pledge to use my leadership role to continue our focus on providing the best possible care for patients, as well as building on our successes for all our stakeholders," Hazen added.
Frist, who expected to become HCA's next chairman, is the son of company founder Thomas Frist Jr. and has been a board member since 2006, the company noted. To this day, the Frist family owns about 20% of HCA's outstanding shares.
"Tommy grew up as part of the HCA Healthcare family. He knows the company and culture very well and shares management’s passion for patient care," said Chad Holliday, who will keep his title as HCA's independennt president director. "We're excited about this transition and expect a continuation of the good governance and operational excellence at HCA Healthcare under his board leadership."
Calling the union 'a combination of equals,' the health system said its talks were completed on an expedited timeline, thanks to early alignment in culture and mission.
Less than seven months after announcing their intent to merge, two Catholic health systems finalized the arrangement Wednesday, forming one of the largest health systems in the country and naming 14 members of the new senior leadership team.
Bon Secours Health System, based in Marriottsville, Maryland, merged with Mercy Health, based in Cincinnati, Ohio, to form what is now Bon Secours Mercy Health, a 43-hospital system based in Cincinnati and operating across seven states.
The organizations, which called their union "a combination of equals," noted in Wednesday's announcement that they were able to finalize the arrangement on an expedited timeline thanks to early alignment of their similar cultures and mission-based commitments to quality care.
The definitive agreement was reached using only internal governance, mission, and legal teams—no outside resources—the organizations said. After the terms of the combination were framed, the organizations hired Deloitte Consulting to help integrate their operations, and that work continues.
The combined entity has been projected to generate nearly $9 billion in annual operating revenues across its more than 1,000 care sites.
The formation of Bon Secours Mercy Health comes amid a flurry of M&A activity among major hospital operators, including large Catholic systems.
Catholic Health Initiatives and Dignity Health announced their merger plans in December, two months ahead of the announcement from Bon Secours and Mercy Health. Advocate Aurora Health formed earlier this year following a mega-merger between Advocate Health Care and Aurora Health Care.
A possible merger between Ascension and Providence St. Joseph Health would have formed a system bigger than HCA Healthcare, making it the largest hospital operator in the country, but talks about such a deal fell apart earlier this year.
Senior Leadership Team
John M. Starcher Jr., JD,who had been serving as president and CEO of Mercy Health, was named president and CEO of the combined Bon Secours Mercy Health in July. Immediately thereafter, Starcher began working to build the new organization's senior leadership team.
The organizations announced nine senior leaders Wednesday who will report directly to Starcher:
"Each of these leaders brings significant experience and a clear vision for how we can work together to ensure patients remain at the center of everything we do," Starcher said in the statement. "Their leadership and expertise will be key to our success as we continue working to integrate physician, clinical and operational leadership across our growing ministry and transform the way we provide care to the communities we serve."
Could this be 'the most dangerous effort to destabilize the American healthcare system yet'? We'll see, but not just yet.
As confirmation hearings continue Wednesday morning in Washington, D.C., for a nominee poised to bring a reliably conservative majority to the U.S. Supreme Court that could shape health policy for decades to come, lawyers for 20 conservative states are gathering in a federal courtroom more than 1,300 miles away, hoping to make their own lasting mark on American healthcare.
The conservative states filed a lawsuit in February to argue the entire Affordable Care Act was rendered unconstitutional when Congress zeroed out the tax penalty tied to the Obama-era law's individual mandate. They will argue Wednesday morning that U.S. District Judge Reed O'Connor in Fort Worth, Texas, should use a preliminary injunction to put the ACA on hold while the legal challenge proceeds.
This inflection point could have wide-ranging consequences, especially if O'Connor were to side with the plaintiffs. Although it's too soon to tell how O'Connor will rule, he has previously blocked regulations that had used the ACA's prohibition of sex-based discriminationto bar insurers and providers from discriminating against transgender patients and women who had undergone an abortion.
"I cannot overstate how much this lawsuit threatens individual and public health," Georges C. Benjamin, executive director of the American Public Health Association, wrote in a dire Los Angeles Times op-ed Tuesday.
Citing data from the Urban Institute, Benjamin argued that overturning the ACA would cause "a catastrophic loss of coverage," with more than 17 million people losing health insurance next year alone.
"This lawsuit could be the most dangerous effort to destabilize the American healthcare system yet," he wrote.
But the actual consequences of a preliminary injunction would not be immediate and might not stick, since the defendants would quickly appeal any such decision, taking the matter all the way to the Supreme Court if necessary, as Julie Rovner wrote Tuesday for Kaiser Health News.
The Intrigue
What makes this suit so intriguing is the way it's being handled by the named defendants. Although the conservative states sued the federal government, the Trump administration's Department of Justice agreed with the plaintiffs on certain points.
The plaintiffs, led by Texas, argue that the entire ACA is legally inseverable from the individual mandate. Since the Supreme Court ruled in 2012 that the individual mandate was authorized by congressional power to tax and since Congress canceled the mandate's tax penalty effective in 2019, the mandate (and, therefore, the entire law) cannot stand, the plaintiffs argue.
Although the DOJ disagrees with the plaintiffs' argument overall, it agrees with the notion that the mandate is unconstitutional and inseverable from key ACA provisions, prompting a contingent of more liberal states, led by California, to step up in defense of the law.
Expect to hear more about this notion of severability. Five law professors who have previously disagreed with each other on ACA-related matters agreed in an amicus briefthat the plaintiffs and DOJ are approaching severability in this case in an "exactly backward" fashion.
"They disregard the clearly expressed intent of Congress and seek judicial invalidation of statutory provisions that Congress chose to leave intact," the professors wrote. "Accepting their invitation to rewrite the ACA under the guise of 'severability' would usurp Congress's role and inject incoherence into this critical area of law."
The nominee's approach to politically charged healthcare topics, such as the ACA and abortion, are among the items at issue in the debate.
Confirmation hearings for U.S. Supreme Court nominee Judge Brett Kavanaugh began with fireworks Tuesday morning before the Senate Judiciary Committee.
Democrats and protestors alike interrupted Chairman Chuck Grassley, R-Iowa, repeatedly in apparent attempts to block the hearing from proceeding. The episode reflects a high-stakes and largely partisan debate that could dramatically impact U.S. healthcare for decades to come.
Kavanaugh, 53, would be the second-youngest member on the court if confirmed, resulting in a 5–4 reliably conservative majority, as NPR reported. His approach to hot-button healthcare topics, such as abortion and the Affordable Care Act, have received particular scrutiny.
On the presidential campaign trail, then-candidate Donald Trump promised to nominate only justices who would overturn Roe v. Wade. Kavanaugh reportedly told one senator that he views Roe as "settled law." But that doesn't necessarily mean he believes Roe can't be overturned, as The Atlantic'sGarrett Epps wrote.
Kavanaugh dissented in an opinion last year, writing that the government has "permissible interests in favoring fetal life, protecting the best interests of a minor, and refraining from facilitating an abortion," and it "may further those interests so long as it does not impose an undue burden on a woman seeking an abortion."
Another healthcare-related decision by Kavanaugh likely to come up is his 2011 dissent holding that the ACA's individual mandate was legal as a tax authorized by the Commerce Clause.
Kavanaugh's reading could come full circle, if a legal challenge launched by conservative statesprogresses to the Supreme Court. The states argue that the entire ACA was rendered unconstitutional when Congress zeroed out the tax penalty tied to the individual mandate, canceling its status as a tax. In response to the lawsuit, the Trump administration abandoned its defense of key ACA provisions.
It's worth noting, though, as Bloomberg's Sahil Kapur did, that Kavanaugh's 2011 ACA ruling effectively "ducked the issue," enabling him to avoid ruling on the ACA's merits. That's significant because some senators have said Kavanaugh's views on the ACA will affect how they vote on his nomination.
While liberals fear that Kavanaugh could contribute to the ACA's dismantling, some conservatives worry he's too moderate on the ACA. Kavanaugh himself has reportedly signaled in private meetings with Democrats that that he's skeptical of certain claimsin the current Republican-led effort to overturn the Obama-era law.
Data point to hundreds of millions of dollars in savings. Industry groups argue the real number is much higher.
Centers for Medicare & Medicaid Services Administrator Seema Verma announced with fanfare this week that the first cohort of Next Generation accountable care organizations saved some $62 million in their first year of operation.
Verma cited the data as "further evidence that ACOs succeed under two-sided risk," bolstering the agency's proposal to overhaul the Medicare Shared Savings Program (MSSP) next year in a way that would require participating ACOs to take on risk sooner than later, making them more like their Next Gen counterparts.
But fresh data CMS released quietly Thursday afternoon suggest that even the MSSP ACOs without downside risk have saved money. The data, which were published online without a press release, show that upside-only MSSP ACOs saved Medicare $291 million for 2012 through 2017 after accounting for bonuses paid to the ACOs, according to analysis released by the National Association of ACOs (NAACOS).
All MSSP ACOs combined, including upside-only and two-sided risk tracks, saved $314 million during that time frame, NAACOS said. (Most of the net savings came earlier, with net losses of $34 million each year in 2016 and 2017.)
"By the most conservative way to evaluate ACO performance using CMS benchmarks, today's results show … what we have been saying for years—that ACOs are saving Medicare hundreds of millions of dollars, and given sufficient time, one-sided ACOs will return significant savings to the trust funds," NAACOS President and CEO Clif Gaus, ScD, said in a statement Thursday.
In response to the Next Gen ACO data release on Monday, Gaus praised CMS for using "the gold standard" methodology to evaluate the model's performance, suggesting that a comparable evaluation of MSSP ACO data would reveal billions of dollars in savings. He echoed that sentiment Thursday.
"When evaluating savings by rigorous scientific methods as opposed to benchmarks, savings to Medicare by one-sided ACOs are magnitudes greater," he said.
Gaus and NAACOS aren't alone in questioning claims that MSSP has cost Medicare. J. Michael McWilliams, MD, PhD, a professor at Harvard Medical School and general internist at Brigham and Women's Hospital in Boston, said in a tweet Thursday that such claims are "frustratingly at odds with consistent findings & conclusions by academic research."
Aledade co-founder and CEO Farzad Mostashari, MD—who favors moving to two-sided risk "to help weed out ACO squatting"—said in a tweet that upside-only MSSP ACOs "more than held their own here." His best guess for how much upside-only MSSP ACOs saved last year is $1.5 billion, less $685 million in payments.
When asked by HealthLeaders for an apples-to-apples comparison of upside-only and two-sided risk models, a CMS spokesperson pointed to Table 14 in the notice of proposed rulemaking regarding the 2019 MSSP ACO overhaul. The table shows that the 410 upside-only MSSP ACOs in performance year 2016 cost Medicare $7 more per beneficiary, while their two-sided risk counterparts saved money.
"The same performance year 2016 data also show that ACOs produce a higher level of net savings and more optimal financial performance results the longer they have been in the Shared Savings Program and with additional participation experience," the proposed rulemaking notes.
Of the MSSP ACOs that began participating in 2012, 42% saved money in 2016. Of those that began in 2013 and 2014, 36% saved money in 2016. Of those that begin in 2015, 26% saved money in 2016. Only 18% of first-year MSSP ACOs saved money in 2016, according to the CMS proposal.
Verma reiterated her reading of the relevant data in a series of tweets shortly after noon on Friday.
"The 2017 results for Medicare’s ACO program continue to show the success of two-sided ACOs as compared to upside-only ACOs and reinforce CMS's commitment to the principles behind the 'Pathways to Success' proposal for ACOs, to accelerate the value-based transformation of America’s healthcare system," Verma said, with links to a press release and blog post released earlier this month. "We look forward to comments on our proposed rule."
Editor's note: This story was updated Friday afternoon to include a comment tweeted by CMS Administrator Seema Verma.
The companies project a sense of optimism as the DOJ's antitrust review chugs along.
Cigna Corp.'s plan to purchase Express Scripts for $52 billion in cash and stock is on track to close by the end of the year, the insurer told federal regulators Monday.
There are some other approvals needed from state and international regulators as well, Cigna noted.
All of this is stacked on top of the Department of Justice's antitrust review, for which both Cigna and Express Scripts submitted additional materials this month, according to the SEC filing.
Because the parties agreed not to close their deal until 90 days after both companies certified that they had substantially complied with the DOJ's second request for information, the earliest this deal will close is mid-November.
Here's how providers can make the most of a 57-page report on electronic health record system safety by Pew, the AMA, and Medstar Health.
Imagine for a moment that a patient in his late 20s arrived in your emergency department with severe flank pain. Based on his allergies and medical history, your team determines that he should be given a high dose of opioid pain medication and monitored closely.
If a physician were to order 10 mg of hydromorphone to be administered intravenously, would your electronic health record (EHR) respond with an alert that this dosage falls outside normal limits? If not, then your EHR would fail one of 14 test-case scenarios included in a report released Tuesday by The Pew Charitable Trusts, the American Medical Association, and Medstar Health. (And that's not the only way your EHR could fail the test.)
The scenarios were developed as tools to help EHR vendors and healthcare providers alike safety-test their systems, both in the development stage and in customized implementation. They include basic and advanced scenarios pertaining to seven different usability issues, and they can be put to use right away.
"There are several important things that can come from this for a provider organization specifically," says Raj Ratwani, PhD, center director and scientific director for MedStar Health's National Center for Human Factors in Healthcare.
Ratwani identified three main steps providers can take to make the most out of the 57-page document.
Step 1: Assess the EHR life cycle.
The report outlines six stages or components of the EHR product life cycle, and it outlines best practices for developers and providers to observe during each stage.
"There are some very, very concrete things that provider organizations can do right now without any kind of formal certification program in place," Ratwani tells HealthLeaders.
Culture of safety: Providers should, among other things, establish defined methods for personnel to report safety hazards related to health IT and an organizational structure to collect and review the identified hazards in a timely manner, according to the report.
Product design and development: Developers should be allowed to observe clinical staff workflows, and clinicians should be permitted to influence an EHR's design and testing, according to the report.
Acquisition: Specific needs and requirements from the provider's clinicians should be detailed for prospective EHR vendors, according to the report.
Customization and configuration: For any customization, there should be a clear justification and documented use cases, with a plan to mitigate associated risks, according to the report.
Implementation and system upgrades: Providers should have a clear governance structure to support the implementation of an EHR system and tackle any safety-related concerns that crop up in the process, taking the lead on testing and software upgrades, according to the report.
Training: Best practices around EHR-related training include providing staggered training to all users, tailoring it to trainee needs, and thoroughly documenting the process and costs, according to the report.
The full list, which can serve as a framework for healthcare leaders to organize their efforts, is included in Table 2 of the report.
Step 2: Use the test cases.
Drawing on feedback from EHR developers, clinicians, and others, the researchers pulled together a list of seven key EHR usability and safety challenge categories: data entry, alerting, interoperability, visual display, availability of information, system automation and defaults, and workflow support.
For each category, the report includes one advanced and one basic test-case scenario designed to assess whether an EHR system and its particular configuration are falling into a potential hazard.
"You could take the test cases that we have, and you could take a subset of your clinicians, and you could have them perform those test cases on your very EHR product that's in clinical use or your training product to see how well clinicians are able to interact with a product, given that particular test case scenario," Ratwani says.
Each scenario includes one or more specific ways an EHR system could fail.
Step 3: Develop your own test cases.
The report is designed as a framework to improve clinical safety related to EHR applications. It's not designed as a comprehensive list of potential pitfalls.
Like a regular automobile inspection, any EHR testing should be an ongoing and iterative process, so providers are encouraged to take the test-case scenario framework and modify it to root out other weaknesses, Ratwani says.
"We encourage providers to do that because each of the EHR implementations across the country is different, and each provider organization may have their own recognized safety hazards that they are attempting to address," he says. "One of the best ways to address those is to use the test case criteria to develop unique test cases relevant to your organization and your implementation to test your system."
A group of about 150 physician groups sent a letter both commending and criticizing the Trump administration's planned changes in the 2019 physician fee schedule.
A letter sent Monday to Centers for Medicare & Medicaid Services Administrator Seema Verma concludes with a long list of physician groups that signed onto the message both praising CMS and questioning the wisdom of certain payment policy changes planned by the agency.
The letter, released by the American Medical Association (AMA), says doctors believe CMS listened to their concerns about the administrative burdens of evaluation and management (E/M) documentation requirements.
"Excessive E/M documentation requirements do not just take time away from patient care; they also make it more difficult to locate medical information in patients' records that is necessary to provide high quality care," it continues. "Physicians and other health care professionals are extremely frustrated by 'note bloat,' with pages and pages of redundant information that makes it difficult to quickly find important information about the patient’s present illness or most recent test results."
The letter comes in response to the proposed physician fee schedule for 2019, which the agency unveiled last month. In addition to the streamlined E/M documentation, the proposal would reduce the number of levels for paperwork and payment—a change that quickly met opposition.
With regard to the proposed payment structure, the letter from the AMA and other physician groups raised concerns about "a number of unanswered questions and potential unintended consequences."
"We oppose the implementation of this proposal because it could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients' access to care," the letter states.
The full letter is available on the AMA website. The deadline to submit a comment on the CMS payment proposal is September 10.
The success story reinforces the need for more downside risk, the CMS administrator argues.
The first cohort of accountable care organizations in the Next Generation model reduced Medicare spending by 1.7% in their first year, about $100 million, according to an annual report released publicly Monday by the Centers for Medicare & Medicaid Services.
After adjusting for shared savings and loss payments to participating ACOs, the model resulted in net savings of 1.1%, or $62 million, according to the report and related materials released to coincide with CMS Administrator Seema Verma's appearance with the Accountable Care Learning Collaborative at Western Governors University.
"These results provide further evidence that ACOs succeed under two-sided risk," Verma said in a statement noting that Next Generation ACOs enjoy "substantial flexibility and regulatory relief" in exchange for taking on the added risk.
"They are delivering value and providing quality care to patients and taxpayers even in their first performance year, and we believe that these results are achievable for other ACOs under similar incentives," she added.
Some industry groups, such as the National Association of ACOs (NAACOS), have said the Trump administration's push to require downside risk earlier is "misguided," "naïve,"and likely to result in significantly fewer participants.
NAACOS President and CEO Clif Gaus released a statement Monday afternoon applauding CMS for using "the gold standard" methodology to evaluate the Next Generation ACO model.
"The results clearly show that Next Gen ACOs, which include mostly experienced Medicare ACOs, collectively saved Medicare money while maintaining quality," Gaus said. "It's important to note that these ACOs have traveled a long way under various models in transitioning to value-based payment care, and we are glad to see CMS recognizing their success."
The more financial risk providers are willing to take, the more flexible CMS will be. #ACLCWebinar
The first cohort in the Next Generation model, for performance year 2016, included only 18 ACOs. But a second and third cohort formed in 2017 and 2018. There are 51 ACOs participating in the model today. By comparison, the Medicare Shared Savings Program (MSSP) has more than 10-times as many ACOs, 561 this year, most of them in tracks that do not include downside risk.
Gaus urged CMS to take a comparably thorough look at MSSP ACOs, arguing that the program has never been subject to a formal evaluation.
"[W]e believe a rigorous independent evaluation would demonstrate that MSSP ACOs have saved billions of dollars while significantly improving quality," Gaus said.
In releasing the report Monday, CMS noted that the Next Generation ACO model entails the highest levels of risk currently included in an ACO initiative offered by the agency.
Editor's note: This story has been updated to include a statement from NAACOS President and CEO Clif Gaus.