NAACOS WEEKLY POLL TRACKS IN-PERSON OFFICE VISITS AT ACOS
As the healthcare system begins to resume “normal” operations under the guidance of CMS, NAACOS is running a weekly survey of ACOs to track the percentage of overall services and expenditures that have resumed. This survey is sent out to all Medicare ACOs, including both NAACOS members and non-members. This process began with a single question designed to determine the effect COVID-19 has had on in-person (non-telehealth) office visits. However, in upcoming weeks, additional questions will be added to learn more about the telehealth visits that are occurring. The results from this past week, the second that the survey was sent, are below.
During the week of May 4, 227 ACOs reported on changes in their in-person office visit volume compared with pre-COVID volume levels. About 25 percent of respondents reported a decline of 60 percent or more in in-person office visit volume. Forty percent of respondents reported declines between 40 and 60 percent. Patterns of reported declines in visits were roughly comparable to ACO reports from last week. Declines in in-person visit volume remained highest in the Northeast and lowest in the West. Declines reported by physician-led and hospital-led ACOs were nearly identical. Overall, there was relatively little change compared with the prior week. Details are provided in the charts.
NAACOS-LED COALITION LETTER RESPONDS TO COVID-19 RULES
NAACOS and eight other leading provider associations recently sent a letter to CMS expressing support for recent policy changes in response to COVID-19 but asked the agency to go farther to support ACOs in the face of the pandemic. Specifically, we are asking that CMS take swift action to:
- Give ACOs an option to be protected from losses in exchange for a reduced shared savings rate, no less than 40 percent;
- Extend the current June MSSP deadline to voluntarily terminate to avoid financial losses to no earlier than October 31;
- Reverse its decision to cancel the 2021 MSSP application cycle; and
- Pay ACO shared savings payments and Advanced Alternative Payment Model (APM) bonuses as soon as possible.
This recent letter is part of our ongoing COVID-19 advocacy, which is detailed on our COVID-19 webpage. NAACOS also sent another letter to CMS with additional detailed requests such as asking the agency to make quality pay-for-reporting for performance year (PY) 2020, update the benchmarking and risk adjustment methodologies to address existing shortcomings highlighted by the pandemic, and more.
TAKE ACTION: SEND COMMENTS TO CMS ABOUT COVID-19 SUPPORT FOR ACOS
NAACOS urges ACOs to send comments in response to CMS’s recent COVID-19 Interim Final Rule with Comment Period (IFC), published May 8 in the Federal Register, and summarized in this NAACOS analysis. Feedback from ACOs to CMS is critical as the agency considers further actions to address the pandemic. There are two ways in which ACOs can submit this feedback.
- Send a brief letter using our Take Action page, which includes a draft letter that you can edit and submit; or
- Submit your own letter in response to the May 8 IFC by going to this regulations.gov page. We encourage members to use any language or text that you find helpful from our own letter.
We recommend ACOs personalize these letters to your own situation and submit feedback as soon as possible.
NAACOS URGES DETAILS ON DIRECT CONTRACTING, EXTENSION OF NEXT GEN
Because of the lack of information from the CMS Innovation Center around the future of both Direct Contracting and the Next Generation (Next Gen) ACO Model, NAACOS sent Innovation Center Director Brad Smith a letter this week asking for changes to certain models in light of the COVID-19 pandemic. The letter has five requests for the Direct Contracting and Next Gen ACO Models:
- Extend the Next Gen Model for at least another year;
- Provide Next Gen ACOs the option to be protected from losses in 2020 in exchange for a reduced shared savings rate of no less than 40 percent;
- Make 2020 quality reporting pay-for-reporting only;
- Pay Next Gen ACOs shared savings payments and APM bonuses as soon as possible; and
- Provide clarity around Direct Contracting as soon as possible so that providers have time to formulate their APM participation plans for the upcoming year.
The Next Generation ACO Model is due to sunset at the end of this year with no public acknowledgement of its future. The application period for the first performance year of the Direct Contracting Model recently came and went without the application portal being opened. NAACOS understands the uncertainty this creates for ACOs and their 2021 participation options, and we hope the Innovation Center will release more information quickly. Read the letter.
HOUSE PASSES PHASE FOUR STIMULUS
On Friday, May 15, U.S. the House of Representatives passed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. The $3 trillion stimulus package represents the priorities of the Democratic caucus and sets a marker for negotiations with Republicans. The HEROES Act includes $200 billion for hazard pay for essential workers, an additional $100 billion for provider relief grants, $75 billion for testing and contact tracing, and changes the repayment terms for the Medicare Advanced Payment Program to allow more time to repay the loans. It’s expected that negotiations will continue into June as the Senate looks at options to assemble their own package. NAACOS will be working with Congressional offices and Administration officials throughout this process to continue advocating for policies that benefit ACOs.
VIRTUAL CONFERENCE COMING IN JUNE
NAACOS has designed a conference program that will engage and provide valuable policy insights and operational strategies for ACOs, with a special focus on dealing with the COVID-19 pandemic. The virtual event will be held mid-day on Tuesdays, Wednesdays, and Thursdays beginning June 9 through June 25. The program will feature 10 sessions originally planned for the spring program conference, six new sessions related to the COVID 19 pandemic, an opening keynote by accountable care thought leader Dr. Don Berwick, and our ever-popular closing townhall with CMS officials. See the entire agenda.
If you registered for the spring conference, you will automatically be registered for the virtual event and be emailed instructions in early June. Register Now!
NAACOS WEBINAR ON RECENT COVID-19 CHANGES FOR ACOS ON-DEMAND
NAACOS recently hosted a webinar, Understanding the Latest Round of COVID-19 Relief from CMS. This webinar reviews CMS’s recent changes made in light of the COVID-19 pandemic, including new policies to exclude COVID-19 costs from 2020 spending, counting telehealth visits in ACO attribution, and cancelling the 2021 application cycle. The webinar is available on-demand for members.
CMS MAKES ACO-14 PAY FOR REPORTING IN 2019
CMS recently announced in the ACO Spotlight Newsletter (Issue 10) that Quality Measure ACO-14, Influenza Immunization, will be made pay-for-reporting retroactively for PY 2019. This is a result of changes to the measure specification resulting from updated clinical guidelines issued by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP). CMS will also remove the measure for purposes of evaluating ACOs in the Merit-Based Incentive Payment System (MIPS).
CMS RELEASES PROPOSED 2021 HOSPITAL INPATIENT PAYMENT RULE
On May 11, CMS released a proposed rule on its 2021 Medicare Hospital Inpatient Prospective Payment System. CMS proposes to collect hospitals’ median payer-specific negotiated charges with Medicare Advantage plans and other third-party payers to use so it could set future Medicare fee-for-service payments.
If finalized, the regulation would postpone CMS’s hospital star-ratings program because of the COVID-19 pandemic and publicly display electronic clinical quality measures on CMS’s Hospital Compare website. CMS estimates the proposed regulation would increase total inpatient payments by 1.6 percent or about $2 billion. CMS issued a related fact sheet. Comments are due July 10.
CMS, OIG ISSUE WAIVER GUIDANCE FOR ACOS THAT INTENDED 2021 MSSP APPLICATIONS
A 2015 regulation from CMS and HHS’s Office of the Inspector General (OIG) that offers wavier protection for arrangements that pre-date an ACO’s participation agreement for one year preceding an application due date provided all of the conditions of a waiver are met. On May 8, the two agencies issued guidance stating they would honor this waiver protection for arrangements that begun as early as June 11, 2019, for ACOs that apply for a 2022 start date since CMS intends to not offer an application period to start in 2021. This would protect ACOs that intended to apply to MSSP later this year and already began to establish programs, which would have been covered by one of MSSP’s waivers. While this move is appreciated, NAACOS hopes CMS will offer some application cycle for ACOs who wish to apply to start in 2021.
BENEFICIARY NOTIFICATION FAQS
In light of the COVID-19 Public Health Emergency (PHE), on May 1 CMS updated FAQs to note the agency is exercising its enforcement discretion to adopt a temporary policy of relaxed enforcement in connection with the deadline for furnishing the standardized written beneficiary notifications required of ACOs, as long as it is completed by the end of the current performance year. Another FAQ notes ACOs can use electronic transmission (such as email or secure portal) in conjunction with e-visits and telehealth visits when completing the beneficiary notification. The new FAQs are listed on page 38.
CMS FAQ ON ACO SHARED LOSS CALCULATIONS MODIFIED BY COVID POLICIES
CMS recently added an FAQ (see page 40) regarding shared losses calculations under the Extreme and Uncontrollable Circumstances policy, triggered in recent Interim Final Rules with comment (IFCs).
Question: If an ACO terminated its Shared Savings Program agreement effective August 31, 2020, and if the ACO were to incur shared losses for performance year 2020, for how many months would the ACO owe shared losses if the Extreme and Uncontrollable policy was triggered?
Answer: The Secretary’s declaration of the COVID-19 Public Health Emergency (PHE) in January 2020 triggered the Medicare Shared Savings Program’s Extreme and Uncontrollable Circumstances Policy. The extreme and uncontrollable circumstance of the COVID-19 PHE began in January 2020 and will apply nationwide for the duration of the PHE for the COVID-19 pandemic. Shared losses will be mitigated for all ACOs participating in a performance-based risk track, including: Track 2, the ENHANCED track, the BASIC track, levels C through E, and the Track 1+ Model, based on the length of the PHE. For example, if the PHE is in effect for 7 months (January through July 2020) any shared losses an ACO incurs for performance year 2020 will be reduced by at least 58.33% (for 7 of the 12 months). Then, if an ACO terminates on August 31st, the ACO would owe 66.66% (for 8 of the 12 months) of any remaining shared losses for performance year 2020 after adjusting for the extreme and uncontrollable circumstance. If the PHE covers the full year (January through December 2020) any shared losses an ACO incurs for performance year 2020 would be reduced completely, and the ACO would not owe any shared losses.
DEADLINE TO VOLUNTARILY TERMINATE TO AVOID FINANCIAL LOSSES REPAYMENT
ACOs wishing to voluntarily terminate and avoid financial reconciliation in the MSSP must do so on or before June 1, with an additional 30 days advance notice provided. The ACO Executive or Authorized to Sign (primary and secondary contacts) must submit a voluntary termination request via the ACO Management System (ACO-MS). All close-out procedures must be completed. More information is available at CFR§425.220 and the CMS Tip Sheet: Submitting a Voluntary Termination Notice (available in the ACO-MS).
MSSP 2020 QUARTER 1 REPORTS
CMS recently noted that MSSP 2020 Quarter 1 (Q1) reports should be available today, May 21. These reports will be available through an ACO’s Managed File Transfer (MFT) mailbox and the SSP ACO Portal. The report package will include: the cover notice, Assignment List Report (ALR) , Assignment Summary Report (ASR), Aggregate Expenditure/Utilization (EXPU) Report, Non-Claims Based Payment File, and 2019 Q4 Claims-Based Quality Measures Report. The PY 2020 Q1 reports were generated before the most recent IFC was released, so it’s important to note that the Q1 reports do not account for the new policies in the IFC. CMS anticipates incorporating these new policies in the PY 2020 Q2 reports available in August.
NAACOS SUPPORTS RISK ADJUSTING AUDIO-ONLY TELEHEALTH VISITS
NAACOS joined several other leading healthcare organizations recently in writing CMS, urging them to count diagnoses obtained from audio-only telehealth services for risk adjustment purposes under the Medicare Advantage program, individual and small group markets, and ACO programs during the ongoing COVID-19 public health emergency. In an April 10 memo, CMS makes it clear that it will only count submitted diagnoses for risk adjustment for video-based telehealth services. With a greater reliance on audio-only or telephone services, NAACOS hopes CMS will expand its inclusion of diagnoses submitted for risk adjustment.
EVALUATIONS RELEASED ON CMS INNOVATION CENTER MODELS
The CMS Innovation Center recently published formal evaluation of three of its many models. The Maryland All-Payer Model reduced hospital spending for both Medicare beneficiaries and commercial plan members and reduced hospital expenditures for Medicare (findings-at-a-glance and full report). CMS determined that the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents found “inconsistent results” (findings-at-a-glance and full report). Results of the Home Health Value-Based Purchasing Model found improvements in quality while reducing overall Medicare spending by 0.9 percent (findings-at-a-glance and full report).
The Innovation Center also recently released a brief on the Accountable Health Communities Model, which aims to connect clinical care and social services to reduce health care utilization and costs for high risk Medicare and Medicaid beneficiaries.
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