Groups Question Changes to Medicare Shared Savings Program
118 out of 220 participating Medicare Shared Savings Program ACOs generated savings through reduced costs, but only 58 of these ACOs managed to meet the shared savings threshold.
- Seventeen medical organizations which includes the American College of Physicians (ACP) and the American Medical Association (AMA) have written a letter commenting on the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Shared Savings Program (MSSP).
Data for the first year of MSSP showed that 118 out of 220 participating MSSP accountable care organizations (ACOs) generated savings through reduced costs, but only 58 of these ACOs managed to meet the shared savings threshold to be given a part of these savings.
The organizations’ comments echo those of American Hospital Association (AHA), which commented on the proposed changes in a letter to CMS on Friday. Just as the AHA indicated, the hospital organizations state the need to be more rewards for the risks that ACOs take on.
“To maximize the MSSP’s impact on quality and costs, CMS must balance its efforts to promote the assumption of greater risk with additional policy to keep current ACOs in the program and attract new participants,” the group writes. “This will ultimately generate the most savings in comparison to the status quo under traditional FFS and is more likely to improve the quality of care.”
In order to balance risk and reward, the organizations recommend the following changes to the CMS’s proposed rule:
- CMS should consider additional ways to remove barriers to financial support
- CMS should allow ACOs to extend their current contract, allowing ACOs more time to determine if they are ready to assume additional risks.
- Contracts should be changed from two-years to five-years to allow ACOs to learn more about MSSP and provide ACOs more stability.
Quality of care is also a major concern for these healthcare organizations.
“Although CMS is setting performance levels for quality measures that demand higher performance on quality, achieving those higher performance levels merely prevents an ACO from having to forfeit the shared savings payments it has earned,” the letter states. “There is no direct financial reward for improving quality of care, and there is no penalty for poor quality unless the ACO has generated savings.”
Additionally, the hospital groups argue that ACOs are less likely to join the MSSP without proper quality of care rewards or incentives. As an ACO attempts to improve quality of care, it will need to spend more and may face a financial burden without further incentive payments.
In order to reward high-quality and well-performing ACOs, the organizations recommend that CMS develop a “sliding scale” which would increase the shared savings threshold to approximately 60 percent.
“While the MSSP program has generated strong interest, sustained and increased participation hinges on the potential financial opportunities being adequate to support the investments needed to improve care and, ultimately, create a program that is sustainable for the long term.” the letter states.
