The CMS has issued an interim final rule to offer accountable-care organizations more leniency on quality reporting standards if they were impacted by natural disasters this year.
The interim final rule proposes to set affected ACOs' minimum quality score to the average quality score for all ACOs in the Medicare Shared Savings Program.
Additionally, the CMS will reduce potential shared losses for affected ACOs in downside risk contracts — those in Tracks 2 or 3 — by the percentage of the ACO's population affected by a disaster.
ACOs that had 20% or more of their assigned beneficiaries living in a county that declared a state of emergency during the 2017 performance year will be eligible for the relaxed reporting standards, the agency said.
The rule is in response to feedback from ACOs in Puerto Rico, Florida, Texas and California that hurricanes and wildfires in their region have greatly impacted their ability to deliver care to their beneficiaries, leading to inefficiencies and more spending.
The CMS made similar reporting changes for physicians affected by disasters who participate in MACRA.
ACOs have reported to the CMS that patients located in affected areas have limited access to primary care or pharmacies, so they are using costly emergency rooms to receive healthcare services. The ability of ACOs to lower readmissions and unplanned admissions impacts their performance in the Shared Savings Program.
Other ACOs have said they have postponed discharge of inpatients because the necessary post-discharge services are unavailable. ACOs have also reported they can't perform preventive services like cancer screening or diabetic eye exams. ACOs are scored in the program based on how often they provide such services.
Medical records to report for the program may even be "inaccessible" for some providers because of natural disasters, the CMS said.
The regulations are set to go into effect Jan. 20, 2018.
