News

Contact:

Sharon Grace
Vice President of Public Relations
703.838.0033 ext. 393
sgrace@amga.org

December 21, 2018

AMGA Sees Value in CMS’ Goals for the Medicare Shared Savings Program
Disappointed Opportunities for Savings Reduced

Alexandria, VA – AMGA and its members voiced support for the Centers for Medicare & Medicaid Services’ (CMS’) vision for the transition to value-based care demonstrated in its Medicare Shared Savings rule. However, they voiced concern that the rule may not be providing sufficient incentives to maintain current ACOs and attract new participants.

“With these policies, CMS is showing its commitment to shifting the MSSP as quickly as possible to a risk-based program,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “While AMGA is a strong supporter of this goal, the program needs to provide additional incentives to ensure the reformed ACO program is successful in moving providers to risk.”

CMS had proposed a shared savings rate of 25% for the upside-only track in the new MSSP glide path. CMS revised this proposal in recognition that such a rate was far too low, but the final rate of 40% also is below the 50% that was previously available to upside-only ACOs.

CMS finalized an accelerated transition to two-side risk, but at the same time reduced the opportunities for those ACOs in risk-based tracks to succeed by reducing the shared savings rate. This creates additional challenges for ACOs, as CMS is increasing the potential losses an ACO faces, while reducing its potential for success. ACOs that are automatically advanced into a risk-bearing track will face an annual increase in their potential for losses, while their shared savings rate remains at 50%.

“CMS is asking ACOs to very quickly move into a risk-based model, which is a policy that AMGA supports,” Penso said. “But, once an ACO is two-sided and more of its revenue is put at risk each year, its possible upside is locked into place at the rate that previously was for upside-only models. We believe this is a missed opportunity to drive providers to the Medicare Shared Savings Program.”

AMGA does support the rule’s expansion of the ability to use of telehealth services and the ability for select ACOs to apply for a Skilled Nursing Facility three-day waiver.

AMGA also is pleased that CMS finalized its proposal to create a beneficiary incentive program. As CMS gains experience with this incentive system, AMGA recommends that CMS consider expanding it to all tracks in the MSSP. AMGA and its members, who are committed to the transition to value-based care, also are ready to serve as a resource to CMS as it refines its proposal to allow Medicare beneficiaries to “opt in” to an ACO.

###

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.