As discussed in our previous blog post 美国CMS宣布新冠肺炎疫情为突发公共卫生事件 (PHE) and published an interim final rule with comment period that includes a number of items 影响医保共享储蓄计划(MSSP)的参与者. This blog post 总结了这些变化以及它们如何影响您的MSSP ACO.
No 2021 MSSP Application Cycle
由于新冠肺炎大流行带来的不确定性, CMS已经取消了从2021年开始作为MSSP ACO参与的申请周期. The reasons for this decision relate to poor benchmarking data from regional ACO claims data and how ACOs might fare in relation to those benchmarks. Some CMS beneficiaries, 例如被诊断患有COVID-19并需要大量住院云顶集团的患者, will have higher-than-expected claims costs. Other beneficiaries will defer services and procedures due to fears about contracting COVID-19, 导致他们的医疗支出被人为压低. 这两种情况都将影响2020年受益人的总体医疗成本, 哪一个将被用来为2021年设定基准, 2022, and 2023 performance years.
由于COVID-19对蚁群算法性能影响的不确定性, CMS决定取消2021年的申请周期, they can “develop approaches to further mitigate the role of 2020 as a benchmark year given the unusual expenditure and utilization trends likely to result from the pandemic.”1
Extension of Current MSSP Contracts into 2021
All MSSP ACOs, regardless of track or level, 这将是他们为期三年的MSSP合同期限在12月31日结束, 2020, 是否可以选择将参与时间延长一年至2021年底. This will allow organizations to focus on the pandemic without the distraction of planning next steps for future MSSP participation. Current historical benchmarks and expenditures used for 2020 will also be used for the 2021 performance year. The decision to extend an MSSP contract must be weighed against the past performance of the ACO, 与ACO参与者的策略愿景保持一致, COVID-19 environmental factors, 以及ACO将在2021年参加的赛道.
如果监理主任决定延长与CMS的合约, updated agreements with all participants/suppliers and SNF affiliates (for those participating in the SNF 3-Day Rule Waiver) will need to be obtained.
“冻结”通往成功的道路
If ACOs elect to extend their participation, 他们将被允许将2020年的赛道保留到2021年. However, in 2022, aco将被要求进入他们在2021年前进的轨道. 那些最初被期望进展到BASIC轨道B的ACOS, C, and D in 2021 will be affected by this update. 基本轨道A和E和增强轨道不受此规则的影响.
- 如前所述,基本轨道A进展到轨道B,没有共同损失.
- 基本轨道E将留在轨道E,除非它选择移动到增强轨道.
表1显示了2021年的MSSP BASIC轨道和选项以及2022年的要求.
If ACOs are in BASIC track B, 它们可以在2021年保持在轨道上,直到2022年才有共同损失的风险. CMS为共同损失风险增加的aco提供了这一选项. ACOs可能会发现获取一种偿还机制, such as a letter of credit, is more challenging in 2020 after the unique cash flow challenges of the COVID-19 pandemic. Additionally, ACOs typically increase their population health infrastructure to prepare for the increased shared savings and possibility of shared losses required for BASIC track C. With the operational challenges of COVID-19, CMS hopes this longer runway will allow ACOs to focus on the pandemic and defer investments on their infrastructure until the PHE has ended.
Much of the track B ACOs’ focus in 2020 has been on caring for their patients during the pandemic, 使准备工作变得困难,因为BASIC轨道C的风险增加了. 尽管CMS允许ACOs在2021年保持其轨道, it is expected that ACOs will use 2021 to prepare for resuming track progression and gliding to the track in which they would have been placed without the “maintain” option.
For those ACOs on BASIC track B, 在没有分担损失风险的情况下再多一年可能会有所帮助. 2021年可用于开发风险较高的BASIC D轨道所需的基础设施. 这包括投入时间考虑和实施偿还机制, identify and develop needed technology, and plan the staffing needs to support the increased population health management responsibilities.
For those ACOs in BASIC tracks C and D, the decision to progress on the track level should be informed by the previous year’s performance. If the ACO has been successful and has confidence in its ability to achieve greater shared savings, 我们建议ACO进展到下一个轨道水平. If an ACO has not had success, we recommend maintaining the current track level to perform root-cause analyses before moving forward.
CMS要求MSSP参与者在7月20日之前表明他们的轨道选举, 2020; this can be revised until September 22, 2020. 有关赛道级别和参与选项的更多信息,请参阅 this CMS document.
Reduction in Shared Losses for ACOs
CMS has determined that the 极端不可控制情况政策适用于新冠肺炎疫情. For ACOs that are in BASIC tracks C, D, and E or the ENHANCED track, 共同损失将根据大流行发生的月数确定比例. More specifically, shared losses will be reduced “by the percentage of the total months in the performance year affected by extreme and uncontrollable circumstance and the percentage of the ACO’s assigned beneficiaries.”2
CMS has defined the time period of the PHE as beginning in January and lasting at least through the end of July. This means that shared losses will be reduced by seven-tenths (January through July) and possibly more based on the progression of the COVID-19 pandemic.
Adjustments to MSSP Calculations
CMS正在努力将医疗云顶集团不规范的影响降到最低, such as increased inpatient stays and decreased elective procedures and preventive care caused by COVID-19. This includes COVID-19 claims expenditures, which will be removed from the following calculations:
- 将适用于共享储蓄的FFS支出
- Historical benchmark calculations
- Performance year expenditures
- Regional and national growth rate factors
- BASIC轨道C、D和E的损失分担限制
- High- or low-revenue ACO identification
Additionally, 2019年的HCC风险评分将用于2021年, 调整疫情DRG权重因子. We are concerned that patients who have opted to delay care may have health deteriorations that would normally be reflected in an increased HCC score. We recommend that health systems factor in this disparity between 2019 HCC coding and 2020 patient health as part of financial forecasting to understand how this will affect services and sustainability.
CMS has indicated that additional detail on these calculations and how pent-up demand from elective procedures might impact MSSP calculations will be coming this summer.
将远程医疗云顶集团纳入受益人分配逻辑
With the COVID-19 pandemic, CMS expanded the services used to assign beneficiaries to ACOs to include primary care and other services provided via telehealth. Telehealth services will be applied to the plurality of services methodology used to determine the provider to whom the patient is assigned.
Next Steps
Based on the current track, success, and infrastructure of the ACO, ECG建议ACOs采取以下措施:
对于截至2020年12月31日的MSSP合同的aco
您的代理是否应该将其MSSP合同延长一年? If the ACO has a track record of success, 预计上述COVID-19因素不会影响ACO的成功, 并准备在2021年参加赛道级别的比赛, ACO可能会决定将合同延长至2021年底.
- Recommendation: 如果行政助理选择延长合同, updated agreements with participants, suppliers, 和SNF附属机构将需要签署提交给CMS.
- By When: CMS要求ACOs在2020年7月20日前提供初步决定. 这一决定可以在2020年9月22日之前进行修改.
- What Should ACOs Do?对于选择将合同延长至12月31日的ACOs, 2021, 以下文件需要更新, signed, and provided to CMS by September 22, 2020:
- 更新与参与者/供应商签署的协议
- 如果参加SNF 3天规则豁免, 更新与SNF附属公司签署的协议
For ACOs on BASIC tracks B, C, and D
你的ACO应该保持当前的轨道水平还是发展到下一个轨道水平? If your ACO has been financially successful, we recommend advancing to the next track level.
- Recommendation: 如果你的助理还没有看到任何共享的节省, 我们建议保持当前的轨道水平.
- By When: CMS要求ACOs在2020年7月20日前提供初步决定. 这一决定可以在2020年9月22日之前进行修改.
- What Should ACOs Do?We recommend ACOs develop financial modeling to understand the different scenarios for each track level.
For All ACOs
在没有更新计算的情况下,ACOs如何预测2021年?
- Recommendation: We recommend ACOs consider that their population of patients may be sicker and have increased HCC scores due to the adverse impacts of COVID-19. This may lead to higher claims costs compared to the benchmark that includes historical HCC scores.
- By When: As this may impact track progression, we recommend conducting forecasting as part of the track progression discussion prior to July 20, 2020.
- What Should ACOs Do?We recommend ACOs develop financial modeling that takes into account the lack of updated calculations to ensure a realistic budget is developed.
心电图继续监测我国应对COVID-19大流行的情况. Visit our COVID-19 thought leadership page regularly for trusted advice on how healthcare leaders and providers can weather this crisis. 如果你对你的助理助理如何最好地应对新的助理助理规则有疑问, 请云顶集团继续对话.
Footnotes
- 1.
“Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC),” pp. 87-88. http://s3.amazonaws.com/public-inspection.federalregister.gov/2020-09608.pdf.
- 2.
“Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC)”, Page 94. http://s3.amazonaws.com/public-inspection.federalregister.gov/2020-09608.pdf.
Published July 6, 2020