New recommendations by the Medicare Payment Advisory Commission (MedPAC) seek to correct how the Centers for Medicare & Medicaid Services (CMS) attributes patients to physicians so most doctors will be able to participate in more than one accountable care organization (ACO) if they so choose.
The recommendations, which the commission made in response to physician concerns raised during a meeting with the AMA and several medical specialty societies, urge the agency to move to a system that would permit most specialists to participate in multiple ACOs in the Shared Savings program.
Under current rules, CMS attributes patients to a particular ACO through a two-step process that effectively has made it impossible for most physicians—including specialists—to participate in more than one organization.
An AMA-formed coalition of medical societies attempted to resolve the issue in repeated meetings with CMS and then took the issue to MedPAC. Under the commission’s plan, primary care physicians still would be exclusive to one ACO, but other specialists would be exclusive only if an ACO identified the specific physician by both his or her tax identification number and National Provider Identifier.
The recommendations also call on CMS to:
- Move to prospective rather than retrospective attribution of patients
- Replace the many process-based ACO quality measures with a small set of population-based outcome measures
- Retain the one-sided risk model for new ACOs but require two-sided risk in future contracts
- Give ACOs the flexibility to waive certain Medicare requirements, including the three-day hospital stay that now is a condition of Medicare coverage for care in a skilled nursing facility
- Clarify the guidelines for communications ACOs can have with patients regarding the advantages of receiving their care through the ACO
- Permit ACOs with two-sided risk contracts to waive some Medicare cost-sharing requirements
The AMA submitted recommendations on the future of the ACO program to CMS in February. The agency is expected to issue a new proposed rule on Medicare ACOs soon.
