Medicare Compliance & Reimbursement

CMS’ policies promote ‘whole-person care.’

With a major overhaul to the Medicare Shared Savings Program (MSSP) last year, you’d think that the feds would scale back their proposals for calendar year (CY) 2024 — but think again.

Refresher: The Centers for Medicare & Medicaid Services (CMS) revamped the MSSP in the CY 2023 Medicare Physician Fee Schedule (MPFS) final rule because the agency felt the much-touted, quality-focused program had plateaued. To beef up participation, CMS decreased administrative burdens, reworked the benchmarking standards, and offered an easier transition process for new accountable care organizations (ACOs) (see Medicare Compliance & Reimbursement, Vol. 48, No. 23).

Now: On Aug. 7, CMS published the CY 2024 MPFS proposed rule in the Federal Register, and the agency again homed in on value-based care with proposals that build on previous policies. In the latest rule, CMS aims to better position the MSSP with the Quality Payment Program (QPP), improve technology standards, and tweak benchmarking methodology and risk adjustment. The agency claims it’s suggesting these changes “to further advance CMS’ overall value-based care strategy of growth, alignment, and equity and to respond to concerns raised by accountable care organizations (ACOs) and other interested parties,” a rule fact sheet explains.

“CMS continues to demonstrate commitment to advancing health equity and building a stronger Medicare program,” says Meena Seshamani, MD, CMS Deputy Administrator and Director of the Center for Medicare, in a release on the proposed rule. “If finalized, the proposals in this rule ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs.”

Add These 5 MSSP Proposals to Your CY 2024 Watchlist

Coordination among providers while offering cost savings to beneficiaries are central themes under the “whole-person care” initiative. The MSSP proposals, which are similar in character to those in the greater CY 2024 MPFS, emphasize CMS’ continued spotlight on wellbeing and behavioral care, equity, and primary care at the foundational level and seek to reward providers for their efforts.

Consider these five MSSP takeaways from the proposed rule:

1. Understand proposed Medicare Clinical Quality Measure (CQM) changes for ACOs. CMS proposes moving ACOs toward “a digital measurement of quality” by jump starting a new Medicare CQMs collection type that aligns with the QPP track Alternative Payment Model (APM) Performance Pathway (APP).

Using MSSP assignment methodology garnered from claims of ACOs with specialty designations, CMS proposes that “Medicare CQMs would serve as a transition collection type to help ACOs build the infrastructure, skills, knowledge, and expertise necessary to report the all payer/all patient Merit-Based Incentive Payment System (MIPS) CQMs and eCQMs,” the agency expounds. “This policy proposal ensures that ACOs have the option to report digitally on their Medicare patients, and that they are not penalized by serving other patients, while also reducing barriers to digital measurement to allow the Shared Savings Program to align with the Universal Foundation for adults in 2025,” the fact sheet notes.

2. Expect a primary care boost in the MSSP. Among the updates, CMS proposes a new definition for primary care services to better align with billing and coding guidelines. “CMS is [also] proposing changes to the assignment methodology that would better promote access to accountable care for individuals who see nurse practitioners, physician assistants, and clinical nurse specialists for their primary care services,” the fact sheet says. These and other proposals support the “whole person care” promise and tie in with the federal campaigns, the CMS Behavioral Health Strategy and the HHS Initiative to Strengthen Primary Care.

3. Get ready for updated CEHRT requirements. The MSSP Certified EHR Technology requirement lacks the general functionality and quality principles inherent in the MIPS Promoting Interoperability standard — and CMS wants to change that. Starting Jan. 1, 2024, CMS proposes nixing the old CEHRT requirements for ACOs in the MSSP and adding a new one that aligns with MIPS for eligible clinicians, “Qualifying APM Participants (QPs), and Partial QPs participating in the ACO, regardless of track,” the fact sheet says.

A public reporting component will also be added to the requirement for ACOs.

4. Prepare for benchmarking modifications. In addition to the beneficiary assignment methodology changes to better acknowledge the roles of primary providers, “CMS also proposes updates to the benchmarking methodology (for agreement periods beginning on January 1, 2024) to further mitigate the impact of the negative regional adjustment and to encourage participation by ACOs caring for medically complex, high-cost beneficiaries,” says McDermott+Consulting, an affiliate of law firm McDermott Will & Emery, in a rule summary.

CMS estimates that the benchmarking changes will boost ACO participation by 10 to 20 percent; moreover, the agency hopes the refinements will bolster beneficiary care.

5. Weigh in on future MSSP changes. CMS is asking for stakeholder input on the following four proposals: adding a higher-risk track beyond the ENHANCED ACO track; altering prior adjustments and scaling to circumvent benchmarking inflation; updating and modifying the Accountable Care Prospective Trend (ACPT); and bolstering coordination between community organizations and ACOs.

Resource: Find the proposed rule and instructions on commenting by Sept. 11 at www.govinfo.gov/content/pkg/FR-2023-08-07/pdf/2023-14624.pdf.