Medicare accountable care organizations are not happy that they have a little more than a month to decide on whether to take on more risk or leave the program.
The CMS on Wednesday gave new ACOs a Feb. 19 deadline to apply to the Pathways to Success program, which forces them to take on more risk than they did in the Medicare Shared Savings Program. But the National Association of ACOs said on Thursday that the deadline is far too short, coming only two months after the CMS published a final rule for Pathways to Success.
"ACOs barely have time to understand the new rules, and organizing an application is very complicated and for some it is now a high-risk decision," NAACOS President Clif Gaus said in a statement.
The association, which has fervently fought the changes to the risk-sharing program, wants the deadline moved to late March.
The CMS published the Pathways to Success rule on Dec. 19. But CMS did not provide the application deadline when it posted the rule.
The CMS told Modern Healthcare there will be two application cycles for ACOs in 2019, and this first deadline is for the July 1, 2019 start date. ACOs joining the second round that starts Jan. 1, 2020 will have a summer deadline.
The Feb. 19 deadline only applies to new ACOs that want to join the program or ACOs that have an existing agreement that has expired. An ACO that has a three-year agreement that expires in either 2019 or 2020 can finish that contract before moving to the new program.
Pathways to Success represents a radical departure from the prior Shared Services Program.
An ACO entering the new five-year program can only be in a one-sided risk track for two to three years depending on how much they earn, with ACOs that generate a low amount of revenue staying in the track longer. After the initial period, they must start to pay the federal government if they don't save enough money in healthcare costs or meet quality requirements.
Under the previous program, an ACO could be in a one-sided risk track for the duration of the five-year contract and not have to pay the federal government anything if they don't meet quality benchmarks or cost metrics.
Existing ACOs also will have to participate in programs that require them to take on more risk in subsequent years.
The NAACOS said that ACOs won't be able to make "several critical decisions," before the Feb. 19 deadline, such as what physicians will participate and signing agreements.
"Setting an application deadline two months after passing the final rule does not give ACOs that have expiring agreements the necessary time to vet the decision internally," Jennifer Moore, chief operating officer at MaineHealth ACO in Portland, Maine, said in a statement.
The CMS told Modern Healthcare that it is providing ACOs with documents and sample applications.
Only a third of ACOs will be subject to the February deadline, according Ashley Ridlon, vice president of health policy for the consulting firm Evolent Health.
There are 561 ACOs that are responsible for 10.5 million Medicare patients, according to data from the CMS.
Ridlon conceded that "the timeline is indeed very tight."
The short turnaround means that hospitals and providers are going to not have a lot of time to think through the pros and cons of whether to apply, said David Muhlestein, chief research officer for the firm Leavitt Partners.
"The timeline is quite short, though doable," Muhlestein said. "Potential participants will need to prioritize this and get their boards, leadership and physicians aligned in a hurry."