AMGA Recommends CMS Improve ACO Program,
Forgo Possible New Direct Provider Contracting Model

Alexandria, VA – AMGA recommends that the Centers for Medicare & Medicaid Services (CMS) focus its attention and efforts toward improving the Medicare Shared Savings Program (MSSP) and accountable care organizations (ACOs) rather than move forward with a new direct provider contracting (DPC) model.

In response to a Request for Information (RFI) that CMS issued on a possible DPC model that also asks whether CMS should instead improve the MSSP, AMGA recommended that CMS instead work to strengthen and refine the existing MSSP program and not divert attention and resources to developing a new demonstration program. AMGA argued that CMS should remain focused on continuing to improve the MSSP rather than launch another, largely duplicative, primary care initiative.

“While it is encouraging that CMS is interested in developing new models that are based on primary care, patients, providers, and the Medicare program would be better served by building on the considerable investments already made in the ACO program,” said Jerry Penso, M.D., M.B.A., AMGA president and chief executive officer. “We’re concerned that if CMS moves forward with a DPC model, it may compromise the MSSP by reducing the number of providers and beneficiaries who participate in a program that is based on the same goals as a potential DPC model.” He added, “The innovations in care delivery and payment envisioned in a DPC model could just as easily be tested in the MSSP or the Comprehensive Primary Care Plus demonstration.”

The RFI acknowledges that a DPC model would largely be duplicative of other CMS models, notably the MSSP and the Comprehensive Primary Care Plus (CPC+) demonstration. As a result, AMGA does not view the DPC model as being sufficiently innovative to warrant an entirely new demonstration program.

“The providers serving more than 10 million Medicare beneficiaries in the MSSP are invested in the ACO model and recognize there are flaws in the program that need to be addressed,” Penso said. “Financial benchmarking, risk adjustment, and quality measurement still need improvement. Reforms should be made in the context of existing programs, rather than a new, rather redundant model.”

The letter is available on the AMGA website.

About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.