The CMS is making changes to Medicare’s accountable care organization program in an effort to jumpstart participation that has recently plateaued, the agency said in its final 2023 Physician Fee Services payment rule released Tuesday.
Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.
With one-sided risk, the ACO can share in savings but does not have to take losses as they do in two-sided risk.
Also, ACOs new to the program will get a one-time payment of $250,000 and quarterly payments for the first two years of participation.
In a bid to improve health equity, the CMS is implementing an adjustment of up to 10 basis points on an ACO’s quality score if it serves a higher proportion of underserved or dually eligible beneficiaries.
The National Association of ACOs generally applauded the changes. “On balance, we believe this final rule will grow participation in accountable care organizations, which have already generated billions of dollars of savings for our health system,” the group said in a statement.
Also in the PFS final rule, the physician payment conversion factor will decline by nearly 4.5% for 2023. The CMS attributed much of the decrease to budget neutrality requirements.
The Medical Group Management Association blasted the cut and said it intends to work with Congress and the Biden administration “to allow physician practices to focus on treating patients instead of scrambling to keep their doors open.”
The AMGA, which also represents medical groups, said that the PFS rate change, along with an upcoming pay-as-you-go cut and the Medicare sequester, will push Medicare payments to providers down 10% in January.
Jefferies analysts said in a note Wednesday they expect Congress to step in and avert some of those cuts.
The CMS said telehealth flexibilities introduced during the COVID-19 public health emergency will remain for about half a year after the PHE ends, so the agency can collect more data for potential permanent changes.
These changes include providing telehealth services in any geographic area and from any originating site.
The rule also finalizes a change in behavioral health requirements, allowing these services to be provided under general supervision of a physician or non-physician practitioner instead of requiring direct supervision. The CMS said it hopes the change will improve access to behavioral healthcare.