January 2019

The December 21, 2018 “Pathways to Success” final rule governing Accountable Care Organizations participating in the Medicare Shared Savings Program (MSSP) will require expedited migration to financial risk arrangements. The final rule will likely trigger a close analysis and create headwinds for the participation strategy of many organizations.  

For ACOs currently participating in the MSSP, the rule further complicates ongoing assessment of current performance, improvement opportunities and the financial and operational details associated with continued participation under the rule’s new “glide path.” Provider communities that are just now considering whether to engage in the MSSP must make a realistic assessment of whether current resources and capabilities align with the new rule’s shortened timeframe to bear performance-based financial risk. 

Overall, the final rule’s numerous highly technical changes represent an improvement over the original proposal which included drastic cuts to the shared savings rate for upside-only ACOs and a more aggressive move to risk for low revenue ACOs than was finalized. Yet the strategic implications of the final rule are sufficiently challenging to lead to a hard study and decision-making by health care providers in crafting future strategies.

Some of the more significant changes in the final rule and their potential implications are described in the full alert, available here.