October 16, 2018: MGMA submits comments on MSSP proposed rule

October 16, 2018 
 
The Honorable Seema Verma
Administrator  
Centers for Medicare & Medicaid Services
Department of Health and Human Services  
200 Independence Avenue, SW  
Washington, DC 20201  
 
RE: CMS-1701-P; Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success Proposed Rule 
 
Dear Administrator Verma:  
 
The Medical Group Management Association (MGMA) is pleased to offer the following comments to the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare Shared Savings Program (MSSP) Pathways to Success proposed rule.  

MGMA is the premier association for professionals who lead medical practice. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 40,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States.

MGMA appreciates CMS’ efforts in the proposed rule to increase stability, predictability, and regulatory burden relief for accountable care organizations (ACOs) participating in the MSSP. However, we have significant concerns regarding some of CMS’ proposals and recommend the Agency revisit proposed policies that would compromise sustained and robust participation in the MSSP. We urge CMS to:

• Increase stability and predictability in the program by finalizing the proposal to lengthen agreement periods to five years. Constant change in payment policies across Medicare programs is disruptive and burdensome; CMS should capitalize on efforts to introduce program stability where it can.
• Allow ACOs more time without downside risk instead of reducing the time in a shared savingsonly model from six to two years. It is critical that CMS provide ACOs with additional time in shared savings-only models to allow for a successful transition from fee-for-service to value-based care.
• Permit ACOs to remain in a shared savings-only model, as opposed to moving to a risk-based model, so long as they meet cost and quality goals. As recent results show that Track 1 participants save money and tend to do so based on experience in the program, MGMA recommends that CMS permit ACOs to remain in a shared savings-only model if the ACO meets performance-based criteria that encourages savings and quality achievements.  
• Instead of requiring ACOs move to the Enhanced track, offer this track as a voluntary option for ACOs prepared for higher levels of risk and reward. As with Track 3, CMS should keep participation in the Enhanced track voluntary and not attempt to push ACOs into a model with levels of risk they are not prepared to assume.
• Maintain a shared savings rate of at least 50 percent for all ACOs in all performance years and tracks to ensure a viable business model. For sustained and robust participation, CMS must structure the program to ensure the MSSP is attractive and viable for new entrants, and MGMA does not believe it is realistic to drop below the current 50 percent shared savings rate.
• Account for changes in ACO patients’ health status over time by allowing for a risk adjustment fluctuation. MGMA supports updating the risk adjustment methodology to account for risk score changes but maintains there are additional improvements that should be made to benchmarking and risk adjustment methodologies.    
• Increase flexibility in the MSSP by finalizing the proposed policy to permit ACOs to select a prospective or retrospective assignment methodology on an annual basis. MGMA has long advocated for policies that permit ACOs to choose between prospective and retrospective assignment, regardless of track, and is encouraged by CMS’ proposal.  
• Remove ACO quality measure 11 and instead rely on attestation to evaluate use of CEHRT. MGMA urges CMS to finalize this proposal and to continue to seek ways to reduce unnecessary reporting requirements. 

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