Here are six key notes:
1. Rather than using national rates, CMS will calculate cost benchmarks for accountable care organizations based on regional healthcare spending trends.
2. CMS intends the updated ruling to stop ACOs from competing against themselves, and use the regional trends to compare their outcomes against other ACOs.
3. The agency will phase in the new ACO methodology starting January 2017. CMS plans to gradually adjust the MSSP program, allowing providers to better prepare and assess healthcare costs that may surpass regional averages.
4. CMS will adjust ACO cost benchmarks for the second or subsequent three-year contract period using the following modifications:
• Use regional trends to establish ACO benchmarks. Regional trends include any county where one or more assigned beneficiary population resides.
• Each year, update the rebased benchmark to include changes in regional fee-for-service spending, as opposed to revising the benchmark based on the absolute amount of projected growth in national fee-for-service spending.
• Recalculate an ACO’s benchmark before the performance year’s start to include regional adjustments, changes in the ACO’s Participate List during the agreement period and determine if the ACO has more spending than other regional ACOs.
5. If an ACO has higher spending than its regional counterparts, it will have a different weight on regional adjustment. CMS will lower the regional adjustment to 25 percent for higher spending ACOs in the first agreement period and to 50 percent in the second agreement period. In the third agreement period, CMS will apply a 70 percent weight to all ACOs when determining the regional adjustment for the cost benchmark.
6. CMS is also expanding its ACO options under MSSP Track One, a one-sided sharing savings model. The update will allow eligible ACOs to renew under a two-sided model for a second agreement period rather than continuing in Track One for a second agreement period or applying to a two-sided risk model. If CMS approves the ACOs renewal, the ACO can request to extend Track One participation for an additional year.
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