While everyone is understandably focused on the day-to-day aspects of the COVID crisis, some attention needs to be directed to the long-term effects on risk-based providers who are tasked with caring for the principal population most at-risk for the virus: the elderly. The author of this article summarizes a survey where 80% of the ACOs expressed concern about their financial performance for 2020, and 56% indicated the possibility of leaving the Medicare Shared Savings Program.
Many of the traditional methods, such as wellness visits, regular exams and chronic care management, used by ACOs to manage high risk populations are not so feasible in the COVID environment. Elderly patients with multiple chronic conditions – the very ones for whom the principles of managing risk have shown cost savings – can quickly decompensate and require expensive care.
MedPAC has proposed to CMS to “skip” 2020 so ACO providers can focus on caring for patients without worrying about their financial performance. While no solution or mitigation has been officially proposed, the looming May 31 deadline for providers to terminate ACO contracts is guaranteed to make this a hot topic very soon.
Update:
On April 30, 2020, CMS announced some expanded flexibilities for ACOs as a result of the COVID-19 crisis:
- ACOs whose agreements end on December 31, 2020, will have the option of extending their participation.
- ACOS in the BASIC track in 2020 can elect to stay there for 2021.
- ACO shared losses due to the public health emergency (PHE) will be adjusted for the total months of the PHE & percent of beneficiaries affected.
- HHS will increase the weight of the COVID-19 DRG by 20%.
- CMS will exclude from ACO benchmarks all Part A & B fee-for-service (FFS) payment amounts for COVID-19 episodes of care triggered by inpatient service. The episode of care is defined as starting in the month the inpatient stay begins, all months of the inpatient stay and the month following the end of the inpatient stay.