Coalition urges CMS to hold ACOs harmless for anomalous catheter spending

Eleven organizations representing health care providers, including the AHA, April 29 urged the Centers for Medicare & Medicaid Services not to hold accountable care organizations responsible for anomalous Medicare spending beyond their control, such as aberrant catheter spending, noting significantly higher spending in 2023 for two catheter codes billed by durable medical equipment suppliers. The Institute for Accountable Care analyzed Medicare claims for those codes from the CMS Virtual Research Data Center and discovered a nearly 20-fold increase over two years - from $153 million in 2021 to $3.1 billion in 2023 - with almost all of the increase attributed to just 10 DME suppliers. The group asks CMS to remove questionable claims from ACO financial calculations, create an outlier policy to account for other forms of anomalous spending, and provide ACOs an option for a second reconciliation.

"We strongly urge CMS to address these policies for the Medicare Shared Savings Program (MSSP), in the upcoming Medicare Physician Fee Schedule proposed rule, and the ACO Realizing Equity, Access, and Community Health (REACH) Model, which doesn't need formal rulemaking," the letter notes. "We also request that CMS continue to work with stakeholders on long-term solutions to address suspected and confirmed fraud."