NAACOS QUALITY RESOURCE ON CRITICAL CHANGES FOR ACOS The Final 2021 Medicare Physician Fee Schedule (MPFS) Rule made sweeping changes to the way Medicare Shared Savings Program (MSSP) ACOs are assessed on quality. NAACOS has developed a new resource outlining these changes for ACOs. The changes represent the biggest shift in how ACOs are evaluated on quality since the program’s inception. Take advantage of this new members-only resource today!
2021 MSSP PARTICIPATION NUMBERS RELEASED Participation in the MSSP unfortunately dropped to a five-year low in 2021, according to new data. There are just 477 ACOs in the program, the lowest since 2017 and down from a high of 561. NAACOS is obviously disappointed with the drop and credits much of the dwindling participation in recent years due to CMS policies like Pathways to Success, which removed incentives for new ACOs to join the program. Our government affairs team continues to advocate for CMS to address ACO incentives to better balance risk and reward. We’ve also asked that there be a July 2021 MSSP class. NAACOS recently issued a press release on 2021 MSSP participation.
NEW CONGRESS OUTLINES PRIORITIES Senate leaders are nearing consensus on a power-sharing agreement that will allow for a change in Senate committee leadership and a reallocation of committee assignments. The delay in reaching an agreement, as well as work on a second impeachment of Former President Trump scheduled to begin February 8, has slowed the confirmation process for a number of President Biden’s nominations, including Health and Human Services (HHS) Secretary nominee Xavier Becerra.
House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Chuck Schumer (D-NY) said that a COVID-19 stimulus package would be one of the first legislative issues Congress will consider. Earlier this month, President Biden unveiled a nearly $2 trillion stimulus package that includes $400 billion for vaccines and testing, $1 trillion in direct stimulus payments and unemployment assistance, and $440 billion in aid to state and local governments and small businesses.
White House economic advisors held a call with a bipartisan group of senators over the weekend to discuss the proposal, but Democratic leaders are discussing using the budget reconciliation process to advance the stimulus package if a bipartisan agreement is not reached in the coming days. While budget reconciliation has a number of limitations, it allows the Senate to advance spending and tax-related legislation with a simple majority vote instead of the 60-vote threshold needed for most legislation.
On the House side, healthcare committees are beginning to outline their legislative agendas and announce their committee rosters. The House Ways and Means Committee Majority released a Framework to Achieve Health and Economic Equity that highlights its key policy objectives this Congress, including “payment reforms and innovation models that over time help sustain improved and expanded health services established through infrastructure investments.”
NAACOS ACO GUIDE TO MACRA: 2021 EDITION NOW AVAILABLE NAACOS has developed the ACO Guide to MACRA to assist members in understanding MACRA’s Quality Payment Program (QPP) policies as they relate to ACOs specifically. This guide is published annually to reflect CMS policy changes in the QPP; NAACOS has just released the 2021 Edition of the guide. In this resource, members can learn about Advanced Alternative Payment Models (APMs), how the Qualifying APM Participant (QP) calculation is completed, and how Merit-Based Incentive Payment System (MIPS) policies apply to ACOs.
NAACOS OVERVIEW OF DIRECT CONTRACTING’S QUALITY APPROACH NAACOS developed a new resource providing an overview of the Direct Contracting Model’s quality measurement methodology. This summarizes more information recently published by the CMS Center for Medicare and Medicaid Innovation (Innovation Center) on what measures will be used, how scoring will be conducted, and how measures will be weighted in the Professional and Global Options of the Direct Contracting Model. CMS plans to use fewer measures than it originally proposed; three claims-based measures in Performance Year 1 with two additional ones proposed for PY 2. Some of the measures will only apply to certain Direct Contracting Entity (DCE) types. Additional NAACOS’s Direct Contracting resources can be found on our page for the model.
Welcome New Associate ACO Members
Nightingale Partners LLC Washington, DC
IowaHealth+ Des Moines, IA
WEBINAR TOMORROW: UNDERSTANDING QPP ALL-PAYER COMBINATION OPTION ACOs participating in Advanced APMs are increasingly pursuing similar contracts with payers outside of traditional Medicare and, as a result, there is growing interest in the All-Payer Combination Option under QPP. That option allows ACOs to earn Advanced APM bonuses based on their participation in Advanced APMs with payers outside of traditional Medicare, along with their Medicare APM participation. NAACOS will host a webinar on January 29 at 2:00–3:00 pm ET to review this QPP option. We look forward to having CMS staff present about the All-Payer Combination Option, explaining the benefits of this option, how the program works, and how ACOs can earn QP status through their All-Payer Combination Option participation. Register today.
MEDICARE ADVANTAGE RATE NOTICE RELEASED Medicare Advantage plans are due to receive an estimated 4 percent more in 2022 than this year under a final rate notice published by CMS this month. The 2022 rate notice fully phases in the Hierarchical Condition Categories (HCC) Risk Adjustment Model that was first implemented in 2020. The HCC Model counts the number of conditions a beneficiary has by using submitted encounter data. Of note, CMS did not include COVID-19 vaccination rates in the agency’s final stars ratings. The agency makes other adjustments related to the pandemic such as the impact of delayed care. The rate notice was published three months earlier to help plans better account for the pandemic in their upcoming bids. CMS has also published a fact sheet on the final notice.
GEO DIRECT CONTRACTING MODEL RFA POSTED The Request for Applications (RFA) for the Geographic Direct Contracting Model (Geo) has been posted to CMS’s website. The RFA has more details on eligibility and participation, beneficiary outreach and education requirements, financial methodology, model overlap, benefit enhancements, beneficiary engagement incentives, capitation payment mechanisms, payment integrity, and medical review. Despite CMS’s moving ahead with Geo, NAACOS wrote Innovation Center leaders last month asking that Geo’s implementation be halted, arguing that certain policy goals would be better tested in Direct Contracting’s Professional and Global Options or other ACO programs. While Professional and Global better mimic legacy ACO programs, Geo would make entities responsible for most traditional Medicare patients in one of 10 regions. CMS expects the application period for Geo to last from March 1 to April 2.
CMS WEB INTERFACE BIWEEKLY SUPPORT CALLS BEGIN CMS has begun hosting 2020 Web Interface reporting biweekly support calls. The first call took place on January 27, and all calls will be held on Wednesdays from 1:00–2:30 pm ET. These calls will highlight important updates on reporting quality data and offer ACOs a chance to ask questions from CMS subject matter experts. The next call will take place on February 10 from 1:00–2:30 pm ET. Information on registering for remaining calls is provided to ACOs through the ACO Spotlight Newsletter. As a reminder, the 2020 ACO Web Interface quality reporting submission period is now open and will close on March 31, 2021. Finally, CMS has an MSSP extreme and uncontrollable circumstances policy that will provide ACOs with the 2020 ACO mean quality score if they are unable to report quality data due to extreme and uncontrollable circumstance, such as the COVID-19 Public Health Emergency. Additionally, in the Final 2021 MPFS Rule CMS notes ACOs that are able to report quality data will be given the higher of their 2020 quality score or the mean MSSP ACO quality score for PY 2020.
ADDITIONAL PY 2018 ADVANCED APM BONUSES TO BE DISTRIBUTED CMS initially distributed 2020 Advanced APM bonuses, based on PY 2018, in the Fall of 2020. For certain eligible clinicians, the agency was unable to verify current banking/Medicare billing information and was unable to issue payments at that time. As noted previously by NAACOS in a newsletter article, CMS published a list of these clinicians and requested they contact the agency with updated billing information. The agency recently noted that it intends to provide an additional round of the 2020 Advanced APM bonuses in the end of January to qualifying providers who have not already received them.
LAST CHANCE TO SUBMIT NAACOS QUALITY AWARDS! The NAACOS Leaders in Quality Excellence awards have been established to recognize the outstanding efforts among ACOs working to improve the quality and safety of patient care and advance population health goals. At this time, we are inviting NAACOS ACO member organizations to submit an entry for a quality project recently taken on by the ACO to improve the quality of care provided to its patients. NAACOS will recognize the top three submissions, selected by the NAACOS Quality Committee, at our Spring 2021 Conference to showcase the exemplary efforts in quality improvement among our members and to disseminate best practices. NAACOS invites ACOs to submit projects that demonstrate innovative quality improvement strategies used by your ACO to improve patient health outcomes. Examples of projects could include initiatives implemented as part of the ACO’s COVID-19 response, programs that address disparities in health outcomes, or other innovative quality improvement strategies used by your ACO to improve patient health outcomes. To be considered, entries must be submitted by January 31, 2021. Please limit entries to one submission per ACO. More information on the award criteria and submissions process are available. Should you have any questions, please contact us at advocacy@naacos.com.
THIRD FORMAL EVALUATION OF CPC+ POSTED A formal evaluation of the Comprehensive Primary Care Plus (CPC+) Model’s third year found it had only a few small favorable effects on service use and quality while increasing Medicare spending. Results are similar to previous years’ findings of the model, which tests whether paying primary care practices care management fees will lower spending and improve quality. The full report and findings-at-a-glance are available online.
Welcome New ACO Members
Best Value Healthcare Belleair, FL
Broward Guardian Hollywood, FL
WATCH OUR ON-DEMAND WEBINAR ON 2021 FEDERAL POLICY OUTLOOK If you weren’t able to catch the NAACOS webinar on the 2021 federal policy outlook, you can now watch it on-demand. NAACOS staff and consultants review what to expect with the new administration and Congress and what that means for ACOs and NAACOS’s advocacy work in Washington. If you have any questions about that work, you can always email us at advocacy@naacos.com.
BUSINESS PARTNER CERNER SPONSORED WEBINAR Join Cerner and NAACOS on February 10 from 2:00–3:00 pm ET for a sponsored webinar: Strategy and Technology Best Practices for Sustainable Year-Over-Year ACO Performance. Speakers Richard Martin, Melody Danko-Holsomback, and Kevin Seabaugh from Geisinger Health System’s MSSP ACO, Keystone ACO, will share their year-over-year value-based strategy evolution, successes and takeaways starting in 2016 and plans for 2021. From leveraging CMS claims data, streamlining analytics, and tapping into health information exchange (HIE) data versus flat file integration, hear how your organization can benefit from Geisinger and Keystone’s strategies and technology best practices that helped lead to earned shared savings as we all navigate the pandemic’s impact into 2021. Geisinger Health System operates as an integrated delivery system, a self-contained health care ecosystem, including administrators, payers and providers. Its goal is to manage the entire patient journey and improve not just individual care but the health of its population. This webinar is free for all ACOs and is not available to business partners. Register today!
