Chairman Brady, Ranking Member Neal and members of the committee, thank you for this opportunity to share the regulatory burdens facing accountable care organizations.
To begin, barriers must be removed to data and ACOs allowed to access real-time care coordination information.
It is widely recognized that giving timely, actionable data to healthcare providers allows them to work closely with beneficiaries to effectively manage chronic conditions or prevent health conditions from worsening. However, to effectively manage a beneficiary’s health, ACOs need more timely and in-depth data. The Centers for Medicare & Medicaid Services (CMS) provides some data but it is delayed by weeks or months and is therefore not always actionable. The data available in the HIPAA Eligibility Transaction System (HETS) is very meaningful and should be provided in real time to ACOs for their beneficiaries. This would allow ACO providers to communicate with treating providers at the hospital and to work with the beneficiary upon his or her release to ensure optimal treatment, medication adherence and follow up care. We therefore request that Congress work with CMS to develop a mechanism to share more robust health data, including that from HETS, with ACOs in real time to enhance care coordination, improve outcomes and reduce costs.
Continuing, CMS should remove regulatory burdens that prevent ACOs from reducing unnecessary costs and improving quality.
There are a number of regulations and requirements that make it harder for ACOs to focus on and achieve their main goals of reducing unnecessary costs and improving quality. We request that Congress work with CMS to remove or limit these barriers to the greatest extent possible. For example, prohibitions on beneficiary engagement should be removed. This would allow ACOs to increase engagement through incentives for beneficiaries to seek treatment from providers the ACO identifies as most efficient and high quality. We also request expanded use of payment rule waivers across ACO models by allowing waivers related to the Skilled Nursing Facility (SNF) 3-day Rule, telehealth, home health and primary care co-payments.
We also request quality reporting burdens be minimized so ACOs are not responsible for over 30 quality measures and instead can focus on fewer measures that are more meaningful for meeting their goals, especially those that are outcomes-based rather than process measures. Finally, we request additional flexibility for ACOs with certain fraud, waste and abuse laws, including thephysician self-referral law. Specifically, we requestincreased Stark Law protection for ACOs, especially as it pertains to addressing the uncertainty about acceptable arrangements with parties outside of the ACO and for patients beyond traditional Medicare.
Finally, provide ACO program flexibility and choice.
CMS dictates a number of program design elements for the Medicare Shared Savings Program (MSSP). While we understand the need to establish certain program elements across ACOs, there are a number of areas where CMS could provide more flexibility and choice for ACOs. For example, we request that regardless of MSSP track, ACOs should be given more choices related to their assignment methodology (retrospective or prospective), timing for moving to a regionally based financial benchmark and timing for when an ACO assumes risk and switches tracks.
Submitted to House Ways and Means Committee March 15, 2018