This week, as a follow-up to an earlier meeting with CMS spearheaded by ASCRS, a task force of medical specialty organizations, including ASCRS, American Medical Association (AMA), Medical Group Management Association (MGMA), American College of Physicians (ACP), and the American Association of Medical Colleges (AAMC) met with CMS officials, at their request, to outline proposed alternatives to the current ACO exclusivity policy regarding physician/group participation in Multiple Medicare ACOs.
As we reported previously and was determined during our first meeting with CMS, although the Medicare Shared Savings Program (MSS) regulation has been interpreted as allowing non-primary care physicians to practice in multiple ACOs, CMS is applying exclusivity more broadly than it had indicated in the final rule and is precluding any practice that performs evaluation and management services (E&M) from full-fledged participation in more than one ACO, regardless of specialty. The goal of this policy is to ensure that only one ACO can claim savings on any given Medicare beneficiary. CMS requested our feedback and asked that we develop alternatives to the current policy. As a result of the first meeting, a coalition of physician organizations was formed to provide CMS with several options for addressing these problems and the resulting consequences. The task force represented the larger coalition at the CMS meeting.
We outlined the proposed solutions, such as allowing participation in multiple ACOs through an opt-in or opt-out by individual provider—as well as at the practice level or using a minimum threshold. In addition, we discussed several actions that needed to take place regardless of the policy—including providing additional guidance for physicians, potential pros and cons of using an “other entity” arrangement to avoid being locked into a single ACO, warning hospitals, ACOs, and ACO applicants about the consequences of making false or misleading statements to physicians and patients regarding the consequences of ACO assignment and participation, and providing beneficiaries with a clear statement from Medicare or the ACO that beneficiaries may continue to receive care for their current physician whether or not these physicians are part of the ACO.
CMS acknowledged the problems and will be reviewing our proposed solutions. They also agreed to provide additional guidance for all parties, as we requested. CMS staff encouraged us to provide them with specific examples of instances where physicians are facing disruptions in current arrangements/networks and with their patients. If you have any examples, please contact ASCRS Director of Government Relations Nancey McCann at firstname.lastname@example.org .
We will continue to keep you updated