A huge chunk of organizations says they would leave the Medicare Shared Savings Program if they’re forced to take on financial risk, which could slow the system’s transition to value-based care. 

It’s also unclear whether the Centers for Medicare & Medicaid Services (CMS), which oversee the program, will make any new changes. A recent letter from the agency offered a vague response about a possible drop in participation, even as another agency indicated it is reviewing proposed changes to the program.

A PDF survey released by the National Association of Accountable Care Organizations (NAACOS) found that 71% of accountable care organizations (ACOs) in non-risk-based tracks that entered the Medicare Shared Savings Program in 2012/13 will leave the program if they are forced to take on financial risk.

Organizations may enter two successive non-risk-based three-year contracts before being forced to enter a financial-risk track, under which they could potentially lose money. NAACOS, which says some organizations are not yet prepared to take on risk, has been pleading for the Medicare agency to allow those ACOs to enter into a third Track 1 agreement period.

Eighty-two ACOs will face the predicament next year, totaling nearly 20% (PDF) of all organizations participating in the program in 2018. NAACOS’ survey found that 66% of those organizations would remain in the program if allowed a third Track 1 contract. 

Responding to a request from the organization to permit ACOs to enter a third non-risk-based contract, CMS offered a vague response that did not directly address NAACOS’ concerns.  The Medicare Shared Savings Program latest results show that ACOs in performance-based risk tracks perform better than shared savings only ACOs."

There is still time for the agency to act. Organizations typically need to notify the agency in May whether they plan to participate in the program the following year. However, Brennan added that the deadline has been pushed back indefinitely due to a new ACO management system, giving the group more time to appeal and the agency more time to decide whether to act. 

A recent study also found that ACOs, as a whole, cost the government much more money than anticipated. The report found that the budget projections for the program in 2010 missed the mark by $2 billion, adding $384 million in costs instead of saving $1.7 billion. 

Information this month says that the OMB is currently reviewing a CMS proposed rule on the Medicare Shared Savings Program, which will include regulatory changes to the program. Details on the regulatory changes are not available, and it is unclear if it will address NAACOS’ dropout concerns. 

Lawmakers are being encouraged to find a path forward on this issue.

Source: FierceHealthcare