March 10, 2020

MedPAC Chairman Drafts Recommendation to Define ACOs by NPIs

The Medicare Payment Advisory Commission (MedPAC) revisited Accountable Care Organization (ACO) assignment at its March 5–6 meeting.

Commission Chair Francis J. Crosson, MD, released a draft recommendation that would require the Secretary of the Department of Health and Human Services to use the same set of National Provider Identifiers (NPIs) to compute both performance year and baseline spending for ACOs in the Medicare Shared Savings Program (MSSP).

The proposal follows concern among the MedPAC members about a possible mismatch between baseline spending and performance year spending because ACOs are currently defined as collection of taxpayer identification numbers. The use of NPIs could avoid unwarranted “shared savings” payments to ACOs that could exceed MSSP savings. A final recommendation will be included in MedPAC’s June 2020 Report to Congress.

The commission also discussed the role of specialists in alternative payment models (APMs) and ACOs. Physician specialty societies have expressed the concern that specialties have limited opportunities in APMs.

Research conducted by MedPAC staff found that specialists have opportunities to participate in APMs, but the ACOs determine the role they are designated to play. Thus far, ACOs with specialists are less likely than ACOs without them to reduce volume and spending.

Additionally, ACOs led by primary care physicians are more selective about participating physicians and may not include specialists, while ACOs affiliated with hospitals tend to include all employed physicians and thus have more specialists. This trend is seen in both MSSPs and Next Gen ACOs.

The commission will meet again in April.