On August 30, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) had saved the Medicare program $1.66 billion in 2021 as compared to spending targets, while delivering high-quality care. According to CMS, this marked the fifth consecutive year the MSSP has generated overall savings as compared to expected Medicare expenditures. CMS Administrator Chiquita Brooks-LaSure stated that "the Medicare Shared Savings Program demonstrates how a coordinated care approach can improve quality and outcomes for people while also reducing costs for the entire health system. Accountable Care Organizations are a true Affordable Care Act story."
The MSSP is the largest value-based program with over 525,000 participating clinicians and providing care in the program to more than 11 million Medicare beneficiaries. CMS just recently, in a proposed rule under the Calendar Year 2023 Physician Fee Schedule, announced revisions to the MSSP designed to encourage broader participation, particularly in rural and underserved areas. Growth in participation in the MSSP had plateaued over the past few years and many of the proposed revisions were designed to address the perceived reasons for the slowing growth in participation.
In announcing the 2021 results, CMS reiterated its goal that 100% of people in Traditional Medicare will be part of an accountable care relationship by 2030.
CMS touted that 99% of MSSP ACOs met the quality requirements to share in savings in 2021 and participating ACOs had a higher mean performance on quality measures compared to clinician groups that were not participating in the MSSP.
CMS also reported that 58% of ACOs participating the MSSP earned shared payments for their performance in 2021. CMS noted that lower revenue ACOs and those with a high percentage of primary care physicians tended to have greater per capita savings. CMS did not comment on the impact of the Covid pandemic on the 2021 results and whether or how much it may have affected reducing utilization and thus reducing Medicare expenditures. Reductions in Medicare utilization should lead to expenditures coming in below the cost benchmarks and thus should generate shared savings payments.
CMS finally emphasized its commitment to advancing health equity. CMS has noted that lower income and members of racial and ethnic communities are underrepresented in the number of Medicare beneficiaries assigned to ACOs. CMS has taken steps in the MSSP and the ACO REACH program to improve access to ACOs of these communities by creating incentives for ACOs with a higher population of such beneficiaries.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
