GNYHA recently submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) proposed changes to the Medicare Shared Savings Program (MSSP) in the calendar year 2023 Physician Fee Schedule proposed rule. CMS proposed to provide advance investment payments (AIPs) to accountable care organizations (ACOs) that are new to MSSP, have low revenue, and are inexperienced with performance-based risk in Medicare ACO initiatives. The level of AIPs partially depends on the socioeconomic status of the ACO’s assigned beneficiaries. GNYHA urged CMS to make AIPs available to all ACOs regardless of current participation in MSSP and revenue status, arguing that this would enable investment in both new and existing health equity initiatives, promote access to accountable care for underserved populations, and promote continued ACO participation in MSSP.
CMS proposed several changes to the current benchmarking methodology that would reduce the impact of ACOs’ prior performance on historical benchmarks and address the impact of market penetration on regional expenditures. GNYHA supported these proposed changes.
CMS also proposed to modify the MSSP quality reporting and quality performance requirements, including introducing a health equity adjustment to an ACO’s quality performance category score that would be tied to the submission of all-payer quality data and establishing a sliding scale for performance measurement that would make shared savings available even when an ACO does not meet the minimum performance threshold. GNYHA supported in concept the proposed health equity adjustment, which provides supplemental quality points based on the number of underserved patients in the ACO’s assigned population, but urged CMS to detach the adjustment from the burdensome shift to all-payer quality data submission. GNYHA also supported the introduction of a sliding scale for performance measurement and the availability of shared savings even in cases in which the minimum performance threshold was not met.
Lastly, GNYHA responded to CMS’s request for information on the screening for social drivers of health and screen positive rate for social drivers of health measures. GNYHA supported the screening measure in concept but cautioned CMS to be mindful of the potential to over-screen patients, which could be detrimental to patient care. GNYHA opposed the use of a screen positive rate for social needs because it is generally a reflection of the population served rather than the care provided and could be easily misinterpreted by the public.