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CMS removes COVID-19 inpatient treatment from ACO performance calculations

The interim rule is extending the mitigation of shared losses back to January 2020.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has released an interim final rule to remove spending associated with COVID-19 patients from performance calculations for the Medicare Shared Savings Program.

CMS is extending its mitigation of shared losses back to January 2020 and is providing flexibility for accountable care organizations to stay in their same risk track next year to help sustain participation in the program for 2020.

The interim final rule is to help mitigate the impact of COVID-19 on ACOs in advance of the deadline for the organizations to leave MSSP without financial penalty.

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The National Association of ACOS wants to see the Medicare Shared Savings Program's dropout deadline at the end of May extended to much later in the year when it said there will be more certainty about the pandemic.

The interim rule also implements additional flexibilities such as expanding audio-only telehealth.

WHY THIS MATTERS

The interim rule removes COVID-19 episodes triggered by an inpatient admission from the calculation of ACO expenditures, but it's unclear if this policy will be sufficient to mitigate exposure to losses, said consultant Premier.

But the interim rule will help ease the concerns of many ACOs, which earlier this month said they might leave the program because of the fear of paying massive losses in the risk-based program due to the effect of COVID-19, according to the NAACOS.

Also, the ACO organization wants CMS to be open to a partial 2021 performance year as the industry stabilizes. With the uncertainty of the length of the public health emergency NAACOS said COVID-related costs should be removed from the entire performance year.

Also, both NAACOS and Premier said they were disappointed to see that new entities will be unable to enter the program until January 2022. There will be no application period in 2021 for new ACOs.

To send a signal that down-side risk entities are valued, CMS should provide a one-time incentive to two-sided risk ACO entities and MACRA bonuses to all clinicians in those ACOs, Premier said.

THE LARGER TREND

January 1 marked the second start date for Accountable Care Organizations participating in a newly redesigned model of the Medicare Shared Savings Program requiring them to take financial risk.

Overall participation in the Medicare Shared Savings Program remained flat following the mandated risk change. In 2020, 517 ACOs are participating in the program, down from a high of 561 two years ago and 518 last year.

ON THE RECORD

NAACOS said, "We hope CMS will continue to work with ACOs to address other issues that are arising, such as making adjustments to standard quality assessments to account for the impact of COVID-19."

Premier said, "Giving ACOs the option to maintain their current level of risk for an additional year and to extend expiring agreements is critical. This will help providers remain focused on their public health emergency response while maintaining their investments in population health."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com