Problems with the CMS ACO exclusivity provision

ACP has been working to address a problem with the “exclusivity provision” of the Medicare Shared Saving (MSS) Accountable Care Organization (ACO) Program.

The provision limits practices to being involved as a formal participant in only one MSS ACO if they submit claims for a set of defined “primary care” codes. This has become a problem particularly for specialty and subspecialty practices in areas where there is more than one approved MSS program. ACOs may try to steer their patients to specialists who are participants with their own MSS. A webinar explaining this issue in further detail is available online.

If you have experienced a problem regarding this “exclusivity” issue, ACP asks that you do the following:

• Notify CMS directly at ShareSavingsProgram@cms.hhs.gov describing any instances in which an MSS program is inappropriately informing their patients that they can only see physicians and other health care professionals within their specific system
• Please contact ACP by email with the subject line MSS PROGRAM describing any other related concerns you have. The College is specifically interested in instances where this situation has significantly decreased a practice's patient panel.