MSSP ACOs save $314 million, as changes loom

Sept. 7, 2018

The 472 Medicare Shared Savings Program (MSSP) ACOs generated $314 million in net savings to Medicare in 2017 after accounting for bonuses paid to ACOs, according to an analysis of performance data quietly released this week by the Centers for Medicare & Medicaid Services (CMS).

“These recent results show that ACOs have turned the corner and this evidence dispels confusion about ACO performance,” Clif Gaus, president and CEO of the National Association of ACOs (NAACOS), said about NAACOS’s analysis of the raw CMS data.

The MSSP ACOs generated gross savings of $1.1 billion—out of $95 billion in Medicare spending—under the CMS methodology for setting financial benchmarks, another analysis by physician advisory group Aledade found.

“That does not count savings that come from lower costs to the taxpayer from Medicare Advantage rates that are keyed off” fee-for-service Medicare, Farzad Mostashari, MD, CEO, of Aledade, wrote on Twitter.

The results were a marked improvement from 2016, when MSSP ACOs provided $652 million in gross savings and a net Medicare loss of $39 million after bonuses were paid.

In 2017, 60% of ACOs saved money and 34% earned shared savings. That was an increase from 56 percent saving money and 31% earning shared savings in 2016, NAACOS found.

The share of ACOs earning shared savings jumped to 51% among those that entered the program in 2012, said Clare Pierce-Wrobel, senior director for the Health Care Transformation Task Force. In comparison, only 20% of the newest ACOs received bonus payments, Muhlestein said.

Other findings of various analyses included:

  • $780 million in shared savings bonuses were paid to ACOs
  • Track 2 and 3 ACOs generated $190 million in savings and received $95 million in bonuses
  • Track 1 ACOs generated $1.5 billion in savings and received $685 million in bonus payments

An analysis by Leavitt Partners found ACOs that were in two-sided risk were just as likely as those in one-sided risk to achieve savings for CMS (60% Track 1 versus 59% in Tracks 2 and 3), but two-sided ACOs were much more likely to achieve bonus payments, Muhlestein said.

The data—released long before the usual October data release—comes as CMS considers an overhaul of the MSSP program, as specified in an Aug. 17 proposed rule.

Among various changes, the CMS overhaul would replace Track 1, which allowed six years of upside only risk, with a new model that would require downside risk within two years.

Beyond the narrowed upside option, ACO advocates are worried that the new ACO structure’s BASIC track would reduce shared savings they could garner from 50% to 25%.

HFMA has the full article

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