The National Association of ACOs sent a letter this week to the Center for Medicare and Medicaid Innovation seeking more information on the future of the direct contracting and Next Generation ACO models.
While industry supported the Direct Contracting Model when it was announced in April 2019, the program has been on an unclear hiatus as the Innovation Center never opened application portal as anticipated in March or offered any additional details on the model. The Next Generation ACO model is slated to end this year after four performance years, but the Innovation Center hasn't offered ACOs any details about how to apply next year for the Medicare Shared Savings Program, according to NAACOS.
"With no 2021 application period for the Medicare Shared Savings Program, our members are increasingly frustrated that they will not have time to evaluate their participation options for the upcoming years," said Clif Gaus, president of NAACOS, in a letter to Innovation Center Director Brad Smith.
In the letter, Gaus asks Smith to extend the Next Generation ACO model for one more year in light of the absent Shared Savings Program application period as well as announce plans for the Direct Contracting Model.
Additionally, NAACOS wants the Innovation Center to adjust how they grade Next Generation ACOs' performance this year in response to the COVID-19 pandemic. The agency made similar concessions for ACOs that participate in the Medicare Shared Savings Program. CMS released a rule in late April changing the MSSP program to help shield ACOs from financial losses, but the rule didn't apply to Next Generation ACOs because they are overseen separately by the Innovation Center.
Participants of Next Generation, which has 41 ACOs this year, take on high amounts of downside risk in exchange for bonuses as a result of improving health outcomes and lowering costs for Medicare beneficiaries. Similar to MSSP ACOs, Next Generation ACOs are concerned they'll be on the hook for penalties this year because projected costs incurred by Medicare beneficiaries is predicted to be higher as a result of COVID-19.
NAACOS is asking the Innovation Center to offer relief to Next Generation ACOs by giving ACOs a reduced shared savings rate in exchange for protection from losses, making 2020 quality reporting pay-for-reporting rather than pay-for-performance and giving out bonuses earlier than late summer or early fall so they can use the funds to deal with decreased revenue.
A CMS spokesman didn't offer details about how the agency will address the models, but said the agency continues "to look closely at all of our models to see where we can take steps to address the unique nature of COVID-19. We look forward to continuing to partner with our model participants, as well as, healthcare providers to continue moving the country towards value-based care."
The agency has suspended many previously mandatory quality reporting requirements, saying it's a way to offer relief to providers at this time so they can focus on the pandemic.