CMS Changes Affecting ACOs in 2023

As the healthcare industry continues to evolve, so do the technologies and systems used to manage and deliver care. In 2023, CMS (Centers for Medicare & Medicaid Services) will be implementing changes that will have a significant impact on ACOs (Accountable Care Organizations).

Overall, these changes are designed to support the growth and success of ACOs in providing high-quality, cost-effective care to their patients. While they may require some adjustments and investments in new technologies, they are ultimately aimed at improving the healthcare system and the overall care for patients they serve.

In this blog, we’re going to review basis point adjustments, telehealth changes, and new improvements in behavioral health delivery for 2023.

Basis Point Adjustments

One change that is taking center stage in 2023 is basis point adjustments of quality scores based on populations served. What will this look like and what does it mean for ACOs?

The most positive impacts of this change will be seen by ACOs with high underserved populations. This is meant to recognize high quality performance for these health systems and incentivize ACOs in the same category to make changes.

CMS believes that these changes will win patients and help providers deliver accountable care to more beneficiaries.

According to the fact sheet that was recently released, the end goal is to “have 100% of traditional Medicare beneficiaries in an accountable care relationship with their healthcare provider by 2030.”

CMS has said that these changes would save Medicare more than $15 billion and result in $650 million in higher shared savings payments to ACOs.

Telehealth Changes

In 2020, telehealth became a popular means of healthcare delivery. The world was on lockdown and patients were afraid to visit their providers for anything but emergencies. In order to protect patients from exposure to Covid-19 and to help doctors deliver care, provisions were made for telehealth services, making it accessible to Medicare beneficiaries.

Those policies were set to expire at the end of 2022, taking telehealth services away from Medicare and Medicaid beneficiaries. Because of this, CMS finalized a proposal that allows physicians and practitioners to continue to bill with the POS indicator that would have been reported had the appointment been completed in person.

This extension is going to be in place until the end of the 2023 calendar year.

The goal is to make a variety of services available via telehealth that were otherwise considered temporary. By continuing this through the end of 2023, CMS is going to gain additional time for the collection of data that may allow for making these services a permanent inclusion to the Medicare Telehealth Services List.

Behavioral Health Requirements: General Supervision Vs. Direct Supervision

One of the most impactful changes that we are seeing from the CMS changes for 2023 revolves around behavioral health and the need to make it more accessible to Medicare and Medicaid beneficiaries without all of the red tape that has been required in the past.

These changes reduce the existing barriers to care access by making LPCs and Licensed Family Therapists amongst others, available without the direct supervision requirement. This allows for general supervision to be conducted by a physician or NPP.

Another interesting thing to note is that CMS is also in the process of finalizing a proposal that allows psychiatric diagnostic evaluation to be the catalyst for the new general behavioral health service.

The Provider's Response

While the three changes discussed in this blog are by no means the full picture, the provider response to these changes have been interesting.

Providers have called for tweaks to the 2023 ACO reforms, and more specifically, are asking to pull back on the 4.5% pay cut that they will experience due to the physician fee cuts that were introduced as part of this reform.

Their argument is that these cuts will hurt providers who are already facing higher costs due to inflation and the economic downturn. This is causing practitioners to consider limiting the number of new Medicare beneficiaries that they are willing to serve.