The Centers for Medicare & Medicaid Services (CMS) issued the proposed Physician Fee Schedule for 2023 on July 7, 2022.
The proposed rule expands access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care. The proposed Fee Schedule also includes proposed changes to the Medicare Shared Savings Program (MSSP) that aim to advance the overall CMS care strategy.
According to a press release, “CMS is proposing changes to the Medicare Shared Savings Program that, if finalized, represent some of the most significant reforms since the final rule that established the program was finalized in November 2011 and ACOs began participating in 2012.”
CMS is proposing advanced shared savings payments for certain new MSSP ACOs – groups of health care providers who deliver coordinated, high-quality care to patients. The goal of these advanced payments would be to address Medicare beneficiaries’ social needs. “This is one of the first times Traditional Medicare payments would be permitted for such uses, and is expected to be an opportunity for providers in rural and other underserved areas to make the investments needed to become an ACO and succeed in the program,” CMS writes in the press release.
Other proposals involve permitting smaller ACOs more time to adjust to downside risk, which according to CMS, may lead to increased participation in rural and underserved communities.
CMS also proposed including a health equity adjustment to the quality performance score assigned to an ACO in order to recognize providers for high-quality care to underserved populations. Adjustments to the financial benchmarks for ACOs are also proposed to encourage more ACOs to participate and succeed.
“[W]e are building on the existing Shared Savings Program benchmarking methodology by proposing modifications to strengthen financial incentives for long term participation by reducing the impact of ACOs’ performance on their benchmarks, to address the impact of ACO market penetration on regional expenditures used to adjust and update benchmarks, and to support the business case for ACOs serving high-risk and high dually eligible populations to participate, which will help sustain participation and grow the program,” CMS states in a fact sheet.
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