The proposed version of the rule, which came out in July, proposed shifting the timeline for the overhaul of ACO quality reporting back two years, extending some telehealth flexibilities, and encouraging more ACO participation by easing escrow payment requirements and streamlining the application process. Caravan sent comments on that rule supporting many of the changes but raising concerns with the lack of implementation guidance around the quality overhaul. Below are some highlights of the final rule.
Physician pay. Due to budget rules set in law, CMS finalized a significant pay reduction for many physician specialties. Coupled with the expiration of a pay bump provided by Congress for 2021, many physicians are facing a pay cut for 2022. Congress would need to pass a new law to avert or reduce this pay cut, as they did in a similar situation last year for 2021 physician pay.
Another delay to quality overhaul. CMS received a lot of concerned comments about the impending quality overhaul for the Medicare Shared Savings Program. In July, CMS had proposed to delay the electronic Clinical Quality Measure (eCQM) requirement for ACOs for two more years, until 2024. That delay was increased to three years in the final rule and the new system won’t kick in until 2025. They are also postponing the increase in the MSSP quality performance standard threshold for one additional year to 2024. In addition, CMS finalized a minimum performance threshold of 75 points for Merit-Based Incentive Payment System (MIPS) for 2022 and an exceptional performance threshold of 89 points.
Telehealth: CMS has finalized its telehealth policies put forward in July. This includes an extension of certain telehealth services through 2023 and an expansion of mental telehealth services. CMS has consistently supported expanded telehealth since the beginning of the pandemic, but Congress will need to step to make these changes meaningful for most patients. In considering options for extending telehealth beyond the COVID-19 public health emergency, policymakers should consider limiting telehealth expansions to alternative payment model arrangements that are already proven to control costs.
Benchmarking: In the July proposal, CMS included a detailed discussion of ways to improve the ACO benchmarking calculation and called for comments. CMS included extensive analysis of several issues concerning ACO benchmarking, including fixing the “rural glitch” and raising the cap on the positive HCC adjustment. Unfortunately, the final rule does not include a full response to those comments or any policy changes that would change the benchmarking formula to incentivize more ACOs to enter and stay in the program.
In the final rule, CMS summarized public comments and signaled that benchmarking changes may be coming under future rulemaking. We look forward to CMS moving forward with meaningful changes that would appropriately reward ACOs for taking a chance on the program and commit to the work of population health management. Now that CMS has made public its goal of getting all Medicare lives into ACOs or other total cost of care arrangements by 2030, they will need every tool possible to encourage participation. We look forward to more engagement on this important topic.
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