CMS introduced Monday that accountable care organizations within the revised Medicare Shared Financial savings Program generated increased financial savings final yr than organizations nonetheless within the legacy mannequin.
Of the 541 ACOs within the Medicare Shared Financial savings Program in 2019, 205 participated for the primary time within the revised program, referred to as Pathways to Success, that includes requiring ACOs to tackle draw back threat prior to within the authentic program. These 205 ACOs achieved on common internet financial savings of $169 per Medicare beneficiary final yr in contrast with $106 in financial savings on common for the 336 ACOs within the legacy tracks, in line with CMS Administrator Seema Verma in a Well being Affairs weblog put up.
Moreover, the 66 new entrants to the ACO program, which joined underneath Pathways to Success, achieved on common $150 in internet financial savings, marking the primary time ACOs new to this system carried out higher than the benchmark, Verma mentioned.
“These early outcomes recommend that larger monetary accountability underneath the Pathways to Success insurance policies has produced the stronger incentives for ACOs to ship higher coordinated and extra environment friendly take care of Medicare beneficiaries,” she mentioned.
CMS overhauled the long-standing Medicare Shared Financial savings Program in December 2018 in response to considerations that this system wasn’t saving the company cash as a result of the overwhelming majority of ACOs stayed in upside-only threat tracks for a few years. The modified program has acquired pushback from the Nationwide Affiliation of ACOs (NAACOS), which argues among the adjustments deter new entrants to this system. Certainly, participation to MSSP has dropped from a peak of 141 new ACOs in 2018, to only 35 new ACOs becoming a member of in 2020, in line with NAACOS.
Total, the 541 ACOs saved Medicare $1.19 billion final yr, which is increased than 2018 when this system saved Medicare about $740 million. CMS generated extra in financial savings with extra ACOs on the hook for losses in the event that they fail to fulfill benchmarks.
Of the 541 ACOs, 150, or 27.7%, have been in a draw back threat observe final yr, in contrast with 2018 when 548 ACOs participated in this system and 95, or 17%, have been in a draw back threat observe.
Another excuse Medicare saved extra final yr is that ACOs general saved extra on common per beneficiary than in 2018, in line with David Pittman, well being coverage and communications adviser at NAACOS. There have been additionally adjustments to the benchmark that account extra for regional spending, he added.
And though the general variety of ACOs in MSSP was smaller final yr than the prior yr, about 1 million extra Medicare beneficiaries have been in this system. There have been 11.2 million beneficiaries in MSSP final yr in contrast with 10.1 million in 2018. There’s proof some ACOs have mixed to type bigger organizations as they tackle draw back threat, hoping scale will offset the potential for devastating losses.
CMS has made substantial adjustments to this system this yr in response to the COVID-19 pandemic by way of emergency rulemaking together with permitting ACOs to hold over their present stage of threat for an additional yr and mitigating the potential for losses.