Premier Joins Other Organizations in Calling on CMS to Hold ACOs Harmless for Anomalous Medicare Spending

Premier joined 10 other national healthcare organizations in calling on CMS to hold accountable care organizations (ACOs) harmless from anomalous Medicare spending outside their control, such as recent aberrant billing for catheters. 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. In a letter to the agency, the groups outlined 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:

• 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; and
• Continue to work with stakeholders on long-term solutions to address suspected and confirmed fraud.