The ENHANCED track, modeled after the existing Track 3 and offering additional tools and flexibility for ACOs that take on the highest level of risk and potential shared savingsīoth the BASIC and ENHANCED tracks feature five-year participation agreements, with variations in when and to what degree a participating ACO must assume the risk.BASIC track, which allows eligible ACOs to begin under a one-sided risk model and gradually increase to higher levels of financial risk.Instead, the Pathways for Success initiative restructures MSSP into two tracks: The final rule discontinues Track 1 and Track 2 under MSSP and similarly discontinues the option for ACOs to renew participation in either track. Overview of pathways to success: BASIC and ENHANCED Tracks Other key provisions of the proposed rule also are summarized. Overall, CMS projects that the final changes will result in a net reduction in Medicare spending of $2.9 billion for the period of 2019 through 2028 an increase from the proposed rule due to higher levels of participation, lower overall shared savings payments to ACOs, and an increase in incentive payments under the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP) for qualifying participants in Advanced Alternative Payment Models.Īdditional details on the “BASIC” and “ENHANCED” tracks are presented below. These estimates represent a smaller decline in participation from the proposed rule, reflecting changes that allow greater flexibility in participation under the new structure. By 2028, CMS estimates that 36 fewer ACOs will participate in the program. CMS reports that 90 percent of ACOs with agreements that expired at the end of the year has signed six-month extensions that would allow them to renew their agreement on July 1 under the new rules.ĬMS estimates that there will be three fewer ACOs participating in MSSP in 2019. Of the 460 Track 1 participant, 82 ACOs’ second participation agreements under Track 1 were due to end on December 31, 2018, requiring them to move into an MSSP track with downside financial risk or leave the program. Projected Impact on MSSP participation, Medicare expendituresĪt the end of 2018, 460 of the 561 MSSP ACOs (82 percent) participated in Track 1, featuring only shared savings. In addition to revenue differences, the final rule makes a new distinction between ACOs that are experienced or inexperienced with performance-based risk Medicare ACO initiatives. The proposed rule indicates that low-revenue ACOs generally will be more common in rural areas and among smaller, physician-only ACOs, while higher-revenue ACOs in many cases will include a hospital. Importantly, the final rule distinguishes between low- and high-revenue ACOs in terms of eligibility to participate in the two payment tracks, moving high-revenue ACOs to a faster pace to risk. After July 1, all ACOs entering new participation agreements will operate under the restructured MSSP program (more detail provided below). The application deadline for all July 1 starts was February 19, 2019. To ensure continuity, current MSSP participants whose agreements would have expired at the end of 2018 had the option to extend their agreement until the July 1 start date. CMS will resume the annual application cycle for the performance year beginning January 1, 2020, and subsequent years. To move forward with the changes, CMS finalized a one-time new agreement period start date of July 1, 2019. Broadly, the MSSP final rule moves ahead with many policies included in the proposed rule, while making certain modifications to meet CMS’ two stated goals of, “Promoting accountability by accelerating the move to two-sided risk while promoting competition by encouraging participation by low revenue ACOs.”
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