ACCOUNTABLE CARE ORGANIZATIONS REQUEST THAT CMS TAKE ACTIONS SHIELDING THEM FROM LOSSES DUE TO COVID-19

 

The National Association of Accountable Care Organizations (NAACO) has asked the Centers for Medicare and Medicaid Services to take actions shielding them from losses due to Covid-19. In a March 16, 2020 e-mail, NAACO asked that CMS exclude spending for Covid-19 patients from expenditures that count toward cost thresholds beyond which an ACO participating in the Medicare Shared Savings Program or the Next Generation ACO Model would be required to reimburse Medicare. In addition, NAACO asked CMS to extend deadlines for submitting quality reporting data applying to certain payment models.

ACOs are groups of hospitals, physicians and other providers who coordinate case with the goal of lowering the cost of care and improving health outcomes. Many ACOs participate in value-based care models with Medicare and other payers pursuant to which they share in the savings when they are successful in improving care and lowering costs. Conversely, when their costs exceed agreed-upon thresholds, they may have to reimburse Medicare or other payers. In the e-mail, NAACO president and CEO Clif Gaus stated: “While ACOs are focused on treating patients, we are reaching out to you [CMS] on their behalf to ensure COVID-19 does not derail the ACO and value movement, which could easily happen if steps aren’t taken by CMS.”

As of January 2020, there were 558 Medicare ACOs serving more than 12.3 million beneficiaries enrolled in Medicare fee-for-service programs. For Whatley Kallas, LLP’s previous article on a 2018 study showing that ACOs saved the Medicare program $2.66 billion, please click here.