ACO Survey Findings and Comments on Quality Benchmark Rule

Nov 10, 2014, 10:47 ET from National Association of ACOs

WASHINGTON, Nov. 10, 2014 /PRNewswire-USNewswire/ -- The National Association of ACOs announces new survey findings and comments on the CMS Final Quality Benchmark Rule.

The National Association of ACOs (NAACOS) is announcing new results to its ACO Tracking Survey. We are reporting updates to the likelihood of ACOs staying in the Medicare Shared Saving Program and the ongoing operational costs of ACOs. The results from the October 2014 survey show that two out of three (66%) MSSP ACOs are highly unlikely or somewhat unlikely to remain in the ACO Program. An additional 26% are undecided. This resulted in only 8% of ACOs being likely to sign a second contract and 92% either unlikely or undecided. NAACOS President, Clif Gaus, commented "this continues to be the most troubling aspect of the Medicare Shared Savings Program and must be sufficiently addressed in the upcoming CMS proposed rules or the MSSP will no longer exist and the high hopes of DC policy-makers to migrate ACOs to capitation and two-sided risk will be impossible."

NAACOS continues to be concerned about the significant investment ACOs are making to sustain their operations. We define those management costs to include, administration, data, compliance, and care coordination costs among others that would not otherwise have been incurred. These did not include costs prior to the operation of their first or current performance year. ACO respondents reported an annual mean of $1.5 million management costs directly attributable to ACO operations. Our previous survey included a higher percent of first year ACOs and that estimate was $2.0 million. When operating costs for the two and half years of the MSSP are totaled, Medicare ACOs have spent over $900 million for care coordination and other operational costs.

On October 31st, CMS finalized changes to the Medicare Shared Savings Program (MSSP) quality measures and benchmarks. While the National Association of ACOs is pleased CMS responded to several ACO provider concerns, we believe that changing 25% of the measures is too disruptive and costly for the ACOs and do little to better inform the consumer. Will continue to recommend fewer and more outcomes focused measures. Further, while CMS will modestly take into account year-over-year increase in each quality measure, the quality measurement system in total will exclusively reduce the savings earned by the ACOs and provide no positive reward for improving the quality of healthcare to Medicare beneficiaries. Instead of a system of rewards and penalties, CMS has chosen to apply the "stick" only approach to ACOs. If the first year of ACO quality measures had counted in calculating Performance Year 1 savings, not one of the 52 ACOs earning shared savings would have retained all of their savings and the total savings going to the ACOs would have been reduced by 25%.  In sum, NAACOS believes CMS failed to strike an adequate balance between changes to the MSSP measure set itself and reforms the agency is making to performance benchmarking. NAACOS President Clif Gaus said, "While CMS has made modest improvement to the ACO Quality Benchmarking, it is still a punitive program that will only lead to future reductions in savings paid to the ACOs who have worked hard to achieve those savings. Coupled with the many attribution and financial benchmarking defects, the Medicare Shared Savings Program is not sustainable in its current configuration and will decelerate the pathway to accountable care for Medicare Beneficiaries."

For additional information on the Survey results, please access the NAACOS Member Newsletter at

SOURCE National Association of ACOs