Sending Office: Honorable Diane Black
Ensure that Accountable Care Organizations (ACOs) continue to generate savings for the Medicare program: Bipartisan Letter to CMS
The Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs) is the most significant national program driving our health care system from fee-for-service volume to value-based care. Today, healthcare in the United State is too expensive
and quality is inconsistent. With 561 ACOs covering 10.5 million Medicare beneficiaries, the MSSP is the largest value based payment model in the United States moving our healthcare system toward better value. The ACO model is a market-based solution that
empowers local physicians, hospitals, and other providers to work together and take responsibility for improving quality and lowering the growth rate of healthcare spending in the Medicare program. Importantly, the ACO model also maintains patient choice
of clinicians and other providers.
These ACOs have been instrumental in the shift to value-based care. A central part of the ACO concept is to transform healthcare through meaningful clinical and operational changes to put patients first by improving their care and reducing unnecessary expenditures.
There is also growing evidence that ACOs save Medicare money. In fact, recent CMS data from 2017 shows net savings to the Medicare Trust Fund of $314 million, which is after accounting for shared savings payments made to ACOs.
In August, CMS issued a proposed rule that would set a new direction for the MSSP, referred to as the “Pathways to Success” Program. While CMS’ recent proposal has a number of improvements to the current program—such as opportunities for reduced regulatory
burden, increased beneficiary engagement, and greater predictability and stability through longer agreement periods—there are concerns in the stakeholder community that CMS’ proposals to shorten the glide path for new ACOs to assume financial risk from 6 years
to 2 years, and to cut the shared savings rate from 50 to 25 percent, will have the unintended impact of impeding new ACO entry and could possibly drive some participating ACOs out of the program.
We urge you to sign this bipartisan letter asking CMS to modify these proposals in the final rule to ensure the long-term viability of this program that is critical in Medicare’s shift to value-based care. If you have questions, or would like to sign onto
the letter, please contact Hillary Lassiter (Rep. Diane Black) or
Isaac Loeb (Rep. Peter Welch). Thank you for your consideration of this request.
Member of Congress
Member of Congress
Dear Administrator Verma:
As supporters of the movement to a value-based health care system that rewards quality and decreases costs, we write to you today regarding the Centers for Medicare & Medicaid Services’ (CMS’) recent proposal
Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success
[CMS-1701-P]. We share CMS’ goal to ensure that Accountable Care Organizations (ACOs) under the voluntary Medicare Shared Savings Program (MSSP) continue to generate savings for the Medicare program and move health care providers toward risk and value-based
The ACO model is a market-based solution that empowers local physicians, hospitals and other providers to work together and take responsibility for improving quality and lowering the growth rate of healthcare spending in the Medicare program. The statistics
are clear: a 2017 Health and Human Services (HHS) Office of Inspector General report found that ACOs achieved high quality and, in particular, noted progress on important measures such as reduced hospital readmissions and screening beneficiaries for risk of
falling and depression.[i] By CMS’ estimates, in 2017, 472 ACOs caring for 9 million beneficiaries participated in the MSSP, generating gross savings of $1.1 billion and an estimated net savings of $314 billion.[ii]
This is consistent with independent research: a new actuarial study found that ACOs saved $1.8 billion from 2013 through 2015 and reduced Medicare spending by $540 million.[iii] Further, peer-reviewed studies by
Harvard University researchers have found that the MSSP saved more than $200 million in 2013 and 2014 and $144.6 million in 2015 after accounting for shared savings bonuses earned by ACOs.[iv]
As we move forward in implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), it is imperative that MSSP ACO participation remains a workable option because MACRA’s fundamental structure is premised on the ability to participate under
an Advanced Alternative Payment Model track, which primarily includes ACO models. While CMS’ recent proposal has a number of improvements to the current program—such as opportunities for reduced regulatory burden, increased beneficiary engagement, and greater
predictability and stability through longer agreement periods—we are concerned that CMS’ proposals to shorten the glide path for new ACOs to assume financial risk from 6 years to 2 years, and to cut the shared savings rate from 50 to 25 percent, will have
the unintended impact of impeding new ACO entry. To ensure that ACOs have a sufficient business case to participate in this voluntary program, we urge CMS to modify these proposals in the final rule.
Thank you for your consideration. We look forward to working with CMS as it continues to incentivize the move from volume to value in health care.
e-Dear Colleague version 2.0