On April 29, Premier, Inc., along with 10 other national healthcare organizations, sent a letter to Centers for Medicare & Medicaid (CMS) urging the agency to hold accountable care organizations (ACOs) harmless from anomalous Medicare spending outside their control, such as recent aberrant billing for catheters.
The healthcare organizations in addition to Premier, Inc. include:
Accountable for Health
- America’s Physician Groups
- American Hospital Association
- American Medical Association
- AMGA
- Association of American Medical Colleges
- Federation of American Hospitals
- Health Care Transformation Task Force
- Medical Group Management Association
- National Association of ACOs
A press release regarding the letter says that “Premier and other organizations have continued to highlight to the Centers for Medicare & Medicaid (CMS) the negative impact that aberrant billing for these codes in 2023 – reaching up to 20 times the usual historical average – will have on ACOs’ ability to capture shared savings.”
The letter outlines steps CMS can take to ensure ACOs are not penalized for this spending and can remain in the models to best serve patients through accountable care including:
- Remove catheter expenditures from ACO financial calculations
- Create an outlier policy to account for other similar variation in anomalous spending
- Provide ACOs an option for a second reconciliation
- Continue to work with stakeholders on long-term solutions to address suspected and confirmed fraud
