Survey: Half of Risk-based ACOs May Drop Out of MSSP

Just over half of the risk-based Medicare Shared Savings Program ACOs say they are likely to drop out of the program because of potential losses related to COVID-19, according to survey results reported today by the ACO trade group, the National Association of ACOs (NAACOs).

NAACOS had previously asked Congress and the Trump administration to cancel all downside risk and the resulting exposure to shared losses for the 2020 performance.

If ACOs in such large numbers were to drop out of MSSP, it would undercut the decade-long effort to shift financial risk and the management of health care to providers through ACOs and the more recent push by the Trump administration to have more Medicare Sharing Savings Program (MSSP) ACOs take on downside risk. ACOs are seen as one of the main vehicles for value-based care and the shiff its proponents want to see from fee for service to payment schemes that reward providers for lowering spending and improving - or at least maintaining - the quality of care.

The trade association says its survey found that representatives of 21% of the risk-based ACOs say their organizations are “very likely” to leave the MSSP program because of COVID-19-related losses. Another 14% rated the chances “likely,  and 21% graded their dropout chances at “somewhat likely.” 

News of the survey results was reported earlier today by FierceHealthcare.

According to NAACOS, the MSSP has a May 31 deadline for risk-based ACOs to give notice whether they are going to continue with the program. If they give notice that they are leaving by then, they can avoid potential losses but also would give up any chance of collecting shared savings.

NAACOS says 226 ACOs responded to the survey it sent out in April. The association’s report on the survey says 40% of Medicare ACOs are in risk-based models, but it doesn’t spell out how many of the respondents to its survey are in that group. No one at the NAACOS was available for comment this afternoon because the NAACOS phone number was busy

According to the report on the survey, about two-thirds (65%) of the respondents said that COVID-19 will have a significant effect on their ability to earn shared savings in 2020.  A quarter (25%) indicated that their 2020 performance year expenditures will increase by greater than 10%, although a larger proportion (37%) said they don’t know what the net effect of COVID-19 will be. While COVID-19 care is expensive,  cancelation or postponement of normal medical services are expected to offset some of that expenditure. Medical expenditures may also decline if COVID-19 leads to an economic downturn.