The CMS is trying to boost patient and provider participation in accountable care organizations by automating the process to pair patients with doctors enrolled in the care models.
In the coming weeks, a Medicare beneficiary can go to a website that contains their enrollment information and list his or her primary-care doctor. If that doctor is in an ACO, they would be assigned to both that provider and their ACO starting next year.
“ACOs have told us they prefer to know with more certainty at the beginning of the performance year what beneficiaries the CMS will hold them accountable for," Dr. Terri Postma, a medical officer in the Center for Medicare, said during a meeting Wednesday with HHS' Advisory Panel on Outreach and Education that ACOs want to know at the beginning of the performance year which beneficiaries they are accountable for.
Providers complain about the current process, in which patients are primarily assigned retroactively to ACOs. That means the CMS will tell a doctor at the end of the year which of their patients' care will be judged to determine success in raising quality of care while reducing costs.
The agency does this to ensure that doctors don't choose only their healthiest patients to participate in their ACOs.
The idea of electronically pairing beneficiaries and ACOs was first proposed in the 2017 physician pay rule released last year.
Providers greeted the news at that time with a mixed reaction. They supported knowing earlier which patients would be involved in ACOs, but they wondered whether patients could easily provide the information.
The American Academy of Family Physicians for instance noted in an August comment letter that Medicare beneficiaries may not have access to a computer or may not understand how to navigate the site. Having an 800 number as a backup wouldn't help older adults that are hard of hearing.
The group urged the CMS to consider two options. Either doing a small pilot program to see if the process would work or use claims submitted by providers to assign beneficiaries.
Postma was seeking help from the Advisory Panel on Outreach and Education Wednesday to get beneficiaries to log on to MyMedicare.gov and select a provider. Postma estimated 30% of Medicare beneficiaries are using the site now.
The group suggested the CMS create a strategy to inform consumers of the benefits of ACOs and the need for them to pick their own doctor.
Following the meeting, Jeff Spight, the president of Collaborative Health Systems, a division of Universal American that operates ACOs, said he wasn't sure the new pairing initiative would be successful.
An earlier ACO participation campaign that asked Medicare enrollees to pick a doctor through a mailed letter fell flat as beneficiaries didn't understand the notices being sent to them, Spight said.
There are now 480 ACOs participating in the Medicare Shared Savings Program overseeing the care of 9 million beneficiaries. Over 55 million people are enrolled in Medicare.