Atypical billing for two catheter codes led to nearly a 20-times increase in spending, the April 29 letter said. In 2021, spending for these codes was $153 million, and in 2023, that figure increased to $3.1 billion.
This expenditure surge is under investigation, and organizations asked CMS to remove the claims from all ACO financial calculations.
“[Five percent] of ACOs would see an impact ranging from $166 per patient per year to well over $1,000 per patient per year” if CMS does not alter calculations, the letter said.
Unadjusted financial calculations “distorts performance and financial benchmarks, creating an apples-to-oranges comparison for both ACOs and CMS,” the organizations said, adding that catheter spending varies across regions.
They also urged CMS to create an outlier policy for unusual spending and offer a second reconciliation to ACOs.
Accountable for Health, America’s Physician Groups, American Hospital Association, American Medical Association, American Medical Group Association, Association of American Medical Colleges, Federation of American Hospitals, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs and Premier penned the letter.
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