ACO Lessons Learned: Revisiting the Timing of Downside Risk

acn14

The editor and publisher of Accountable Care News have been generous in allowing me to republish my article from the November 2014 issue.

Click here to download a .pdf copy of the article. It’s in-depth — about 2,000 words.

Here’s the article in a nutshell:

One of the most critical aspects of the Medicare Shared Savings Program (MSSP) ACO has been around the timing and certainty of requiring mandatory downside financial risk for physician and hospital participants. Provider protests cajoled CMS to backing off an initial stance of “firm and unwavering” for ACO mandatory risk requirements in 2011.

The issue is being revisited in major 2014 MSSP reg revisions which are in process. A central lesson we are learning about ACOs is that clinical transformation is a long and difficult process, and thus CMS (and all payers) should continue to be “firm but flexible” in the timing of requiring downside risk. There are many advantages of a stance of “firm but flexible”, and while the shift in wording might seem subtle, the implications are profound.