Pathways to Success: Medicare Shared Savings Program Overhaul and Changes to ACOs

Assumption of Risk, Benchmark Methodology, Expanded Telehealth Services, SNF Waivers

Recording of a 90-minute CLE webinar with Q&A


Conducted on Wednesday, March 27, 2019

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will guide healthcare counsel on the Centers for Medicare & Medicaid Services (CMS) final rule. The panel will examine the redesigned Medicare Shared Savings Program (MSSP) for Accountable Care Organizations (ACOs), the background behind the redesign, the impact on ACOs, the new participation options under the MSSP, changes to the benchmark methodology, new consequences for ACOs terminating early and those rejoining the MSSP, changes to the repayment mechanism, and risk adjustment. The panel will also address the expanded use of telehealth services and the three-day acute-care stay for skilled nursing facility (SNF) admission waivers.

Description

On Dec. 21, 2018, the CMS issued a final rule overhauling the MSSP for ACOs by establishing the Pathways to Success program. The rule redesigns significant aspects of the MSSP for all new and renewing ACOs. The MSSP is the most utilized Alternative Payment Program with over 550 ACOs participating and serving over 10.5 million Medicare beneficiaries.

A two-track system, basic and enhanced, will replace the current MSSP three participation track system. The track impacts shared shavings as well as the level and assumption of risk by the ACOs. The new tracks move ACOs to take risk more quickly. New classifications of “low revenue,” “high revenue,” “experienced,” and “inexperienced” ACOs are introduced which may affect the timing of the glide path to downside risk.

Further changes include updates to the MSSP benchmarking methodology, a longer agreement term, consequences for early termination, and more review of those renewing or rejoining the MSSP, as well as enhanced beneficiary incentive programs for primary care services. The final rule also expands the use of waivers for telehealth services and the three-day acute care stay requirement prior to SNF admissions.

Listen as our authoritative panel of healthcare counsel examines the CMS final rule overhauling the MSSP for ACOs. The panel will discuss the new MSSP paths, changes to the benchmark methodology and risk adjustment. The panel will also address the expanded use of telehealth services and the three-day SNF waivers.

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Outline

  1. CMS final rule and Pathways to Success program
    1. Redesign of MSSP
    2. Impact on ACOs
  2. Participation options for ACOs
  3. Benchmark methodology
  4. Changes for those terminating participation early and for participants rejoining
  5. Expansion of waivers for telehealth services, three-day acute stay, beneficiary inducements
  6. Participation considerations

Benefits

The panel will review these and other key issues:

  • How do the new basic and enhanced tracks impact ACO risks?
  • What changes does the final rule make to benchmark methodology? To beneficiary incentive programs?
  • What steps should healthcare providers take in light of the CMS final rule overhaul of the MSSP?

Faculty

Bortniker, Alexis
Alexis Finkelberg Bortniker

Partner
Foley & Lardner

Ms. Bortniker is a member of the firm’s Healthcare Industry Team. Her practice focuses on transactional and...  |  Read More

Geilfuss, C. Frederick
C. Frederick Geilfuss, II

Partner
Foley & Lardner

Mr. Geilfuss counsels healthcare providers on regulatory and business matters. He is experienced in healthcare...  |  Read More

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