Medicare & Accountable Care Organizations

To manage population health, accountable care organizations were formed to administer, finance and manage risk while coordinating high-quality care to patients (CMS.gov, 2019). The benefits of the ACO model is that providers can share in cost savings if they achieve quality standards and better prepare for a future where value-based payment models preside. In a recent article by Jacqueline LaPointe of RevCycleIntelligence.com, accountable care organizations have sent notice of downside financial risk adoption to the CMS Innovation Center to have a methodical, public process for alternative payment models or APMs. The benefits of having a public process would be that providers would be better able to predict and take on downside financial risk from APMs. Unlike Medicare Advantage rate notices and call letters, CMS’s Innovation Center APMs do not communicate changes as they occur but in contract amendments long after the fact and halfway into the year making ACO downside financial risk models unreliable and unpredictable (LaPointe, 2019).

            This notice sent to CMS is justified because ACOs and provider organizations, whether they be public or private, need to be able to have predictable financial models that account for any downside risks. It would be fiduciarily irresponsible for CMS, currently run by Ms. Seema Verma, to not oblige to these requests and politicizing the issue along partisan lines. By obliging to these requests, ACOs can better evaluate and compare payment models (LaPointe, 2019). Any value-based care models proposed by CMS’s Innovation Center that has higher risk rewards must be predictable for ACOs to fully embrace the future.

            To date, only four alternative payment models out of 45 proposed by CMS were successful at reducing costs with a net neutral or positive impact on quality of care. Why should ACOs have to take on downside risk that come along when CMS’s Innovation Center is the one baking the cake? That is exactly what CMS is proposing and partisan bickering does nothing but fan the flames. CMS’s Seems Verma stated, “ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up, and this has to change” (LaPointe, 2019). I wholeheartedly disagree with her sentiments because if Medicare ACOs were to take on the financial consequences of costs going up, then those costs would be passed on to the consumer. Medicare consumers are elderly and disabled patients with limited incomes—this is unethical, immoral leadership at the CMS. Medicare was designed to serve the public good, not rack up profits for Medicare Advantage insurance plans. CMS needs to clean up their act.

References

CMS.gov. (2019, March 31). Accountable Care Organizations (ACOs). Retrieved from CMS.gov: https://www.cms.gov/medicare/medicare-fee-for-service-payment/aco/

LaPointe, J. (2019, Apr 01). ACOs Seek CMMI Transparency for Downside Financial Risk Adoption. Retrieved from RevCycleIntelligence: https://revcycleintelligence.com/news/acos-seek-cmmi-transparency-for-downside-financial-risk-adopttion