ED Coding & Reimbursement Alert - 2019 Issue 2
Medicare Policy: ACOs: ‘Pathways to Success’ Reshapes MSSP
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Article Overview
This article explains CMS’s overhaul of the Medicare Shared Savings Program under the “Pathways to Success” framework and summarizes why the agency says the changes are being made. It also discusses the implementation timeline, the move toward greater financial risk in ACO participation, and reactions from provider and hospital groups. The piece is useful for people tracking Medicare value-based payment policy, ACO program changes, and related compliance or operational planning.
Why This Topic Matters
The article is relevant to organizations involved in Medicare ACO participation because it describes a major program redesign that affects participation timing, financial exposure, and strategic planning.
Article Sections
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Background
Provides context for the MSSP overhaul and summarizes how CMS framed the program changes in the final rule. It also notes the broad policy direction behind the update.
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Why the Changes Now?
Explains CMS’s stated rationale for revising the program and places the change within Medicare’s broader value-based care strategy. It also includes high-level program statistics and agency estimates.
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Fast-Paced Implementation Vexes Industry Insiders
Describes concerns about the speed of implementation and summarizes feedback from provider organizations and hospital groups. It focuses on reactions to the transition timeline and overall program direction.
What You Will Learn
- How CMS is restructuring the Medicare Shared Savings Program for ACOs
- The policy rationale CMS gives for increasing program risk and changing participation requirements
- Why provider organizations and hospitals are concerned about the implementation timeline
- How the article frames the broader shift toward value-based Medicare payment
Who Should Read This
- Medical coders
- Healthcare compliance professionals
- ACO administrators
- Hospital revenue cycle leaders
- Practice managers
- Healthcare policy analysts
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