ACOs in Medicare Shared Savings Program post third year of savings

By | September 16, 2020

Dive Brief:

  • The Medicare Shared Savings Program saved the agency $ 1.19 billion in 2019, according to CMS performance results of 541 accountable care organizations released Monday.
  • This marks the third year of savings for the value-based care program and its largest yet, CMS Administrator Seema Verma wrote in a Health Affairs blog post Monday. ACOs taking on more risk continued to outperform those that didn’t, Verma wrote, including those under its Pathways to Success rule rolled out in December 2018.
  • ACOs in the Pathways to Success program generated net per-beneficiary savings of $ 169 compared to $ 106 for legacy track ACOs, Verma said, suggesting the policies are incentivizing ACOs to deliver more coordinated and efficient care.

Dive Insight:

ACOs are groups of doctors, hospitals and other providers with payments tied to the cost and quality of care they provide beneficiaries. According to Verma’s post, the number of ACOs taking on downside financial risk has nearly doubled since the Pathways to Success program launched for those in the Medicare Shared Savings Program.

New participation options under the rule require accountability for spending increases, generally after two years for new ACOs, and close evaluation of care quality. The new benchmarks and speed at which ACOs would need to take on downside risk was initially shot down by ACOs.

But CMS also created an option for “low-revenue” ACOs, generally run by physician practices rather than hospitals, allowing them an additional year before taking on downside risk for cost increases.

According to the blog post, physician-led ACOs performed better than hospital-led ACOs.

But the National Association of Accountable Care Organizations said only 5% of eligible ACOs took CMS’ offer on the Pathways to Success program structure early and instead chose to remain under the previous MSSP rules.

“To get program growth back on track, Congress needs to take a close look at the Value in Health Care Act, which makes several improvements to the Medicare ACO program and better incentivizes Advanced Alternative Payment Models,” trade group CEO Clif Gaus said in a statement.

Farzad Mostashari, CEO of the Aledade, pointed to physician-led ACOs out-performing hospital ACOs in a statement on the results. “What we need now is to help more practices participate in these models of care,” he said.

Low-revenue ACOs, typically physician-led, had per beneficiary savings of $ 201 compared to $ 80 per beneficiary for high-revenue ACOs. Low-revenue ACOs in the Pathways to Success program saved $ 189 per beneficiary while high-revenue ACOs in the program saved $ 155 per beneficiary, according to the 2019 performance results.

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