The COVID-19 pandemic has significantly challenged clinician practices, hospitals, and all health care delivery organizations. Many such organizations have scrambled to build new capabilities and shift workflows to test, trace, and manage COVID-19 as well as remotely manage chronic conditions for their non-COVID patients.
At the same time, health care delivery organizations are facing considerable financial struggles, with elective procedures and non-urgent office visits down by 70-80 percent in many practices. As a result, organizations receiving fee-for-service (FFS) payments have seen their revenues decline precipitously. This lack of capital affects their ability to adapt and respond to the pandemic.
The health care delivery organizations that have best been able to work through the pandemic have been those participating in more advanced alternative payment models (APMs). Recognizing the challenges clinicians and delivery systems are facing, the Centers for Medicare and Medicaid Services (CMS) on April 30 announced multiple regulatory changes to payment models in response to the pandemic. These included several important flexibilities to help Accountable Care Organizations (ACOs) stay in the Medicare Shared Savings Program (MSSP) and care for patients. For example, ACOs with contracts expiring in 2020 can be extended for another year, and ACOs in the BASIC track can remain in their current risk level for another year without progressing