Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Medicare Shared Savings Program

A Holistic View of the Patient Enables Risk-Based ACO Success

March 12, 2018 - Giving providers a holistic view of the patient resulted in accountable care organization (ACO) success for a risk-based organization in southern Florida, which earned a place on the list of ACOs achieving the greatest shared savings in the Medicare Shared Savings Program (MSSP) in 2016. Millennium Physician Group’s Track 3 MSSP ACO earned an impressive $18.5 million in shared savings...


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Orgs Push for MSSP Track 1 Extension for Non-Risk-Bearing ACOs

by Jacqueline Belliveau

Six healthcare industry groups are urging CMS to extend participation in the Medicare Shared Savings Program (MSSP) Track 1 beyond two agreement periods to allow accountable care organizations (ACOs) more time to assume downside financial risk....

MSSP ACOs Save More By Spending Less on Inpatient, Post-Acute Care

by Jacqueline Belliveau

Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) have shifted their spending to physician services and away from inpatient and skilled nursing facility care, according to a recent study in the American Journal of Accountable...

Risk-Averse MSSP ACOs Missed $966M By Not Assuming Downside Risk

by Jacqueline Belliveau

Accountable care organizations (ACOs) in the non-risk bearing track of the Medicare Shared Savings Program (MSSP) could have boosted their bottom lines by an additional $966 million in net payments in 2016 if they had assumed downside risk in...

MSSP Accountable Care Organizations Moving to Risk in 2018

by Jacqueline Belliveau

According to a new fact sheet from CMS, the Medicare Shared Savings Program (MSSP) will see some fresh faces in 2018, as well as more accountable care organizations (ACOs) entering downside financial risk tracks. The federal agency reported that...

New Reporting, Shared Losses Rules for MSSP ACOs in Disaster Areas

by Jacqueline Belliveau

In a new interim final rule, CMS modified quality reporting and shared losses policies for Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) affected by recent natural disasters, such as this year’s major hurricanes...

High-Risk Patient Management Did Not Drive Early ACO Cost Savings

by Jacqueline Belliveau

Care coordination and care management strategies focused on high-risk and chronically ill patients did not drive early cost savings among accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP), a recent Health Affairs...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings

by Jacqueline Belliveau

Medicare accountable care organizations (ACOs) found overwhelming success with care quality improvements in 2016, but the organizations were still working on reducing costs, according to a recent analysis published in the Health Affairs blog....

Accountable Care Organizations Cut Medicare Spending by $836M

by Jacqueline Belliveau

Accountable care organizations (ACOs) decreased Medicare spending by $836 million in 2016, new data from CMS revealed. As a result, the organizations from four Medicare ACO programs returned about $70.6 million in healthcare savings to the Medicare...

MSSP ACOs Decreased Spending by $1B, Improved Care Quality

by Jacqueline Belliveau

Accountable care organizations (ACOs) participating in the first three years of the Medicare Shared Savings Program (MSSP) reduced Medicare spending, with a net reduction of almost $1 billion, according to a new OIG report. The analysis of 428...

Targeting Skilled Nursing Facility, ESRD Care Saves ACO $15M

by Jacqueline Belliveau

A Medicare Shared Savings Program (MSSP) accountable care organization (ACO) realized over $15 million in healthcare savings between 2014 and 2015 by improving skilled nursing facility utilization and targeting end-stage renal disease care, a...

AHA to IRS: Foster Hospital Participation in Commercial ACOs

by Jacqueline Belliveau

The American Hospital Association (AHA) recently called on leaders from the Department of Treasury and IRS to issue formal guidance that would permit non-profit hospitals to participate in commercial accountable care organizations (ACOs) without...

2012 MSSP ACOs Decreased Post-Acute Care Spending by 9%

by Jacqueline Belliveau

A new JAMA Internal Medicine study showed that Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) established in 2012 decreased post-acute care spending by a 9 percent differential reduction by 2014 without compromising...

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

by Jacqueline Belliveau

In a new Medicare Shared Savings Program (MSSP) Track 1+ fact sheet, CMS clarified model details for 2018 to 2020 participation, including maximum shared savings and losses rates, risk assignments, and eligibility requirements. CMS announced...

What is the Medicare Shared Savings Program Track 1+ Model?

by Jacqueline Belliveau

As the Quality Payment Program links more Medicare payments to value-based reimbursement, a new Medicare Shared Savings Program (MSSP) track will allow eligible clinicians to qualify for additional incentive payments in the program’s Advanced...

How Palliative Care Can Maximize Value-Based Reimbursement

by Jacqueline Belliveau

Providers can boost value-based reimbursement success by incorporating early palliative care into routine cancer care delivery, a new study in the American Journal of Managed Care indicated. Researchers at the Center to Advance Palliative Care...

61% of ACO Contracts Only Include Upside Financial Risk

by Jacqueline Belliveau

A recent Leavitt Partners study showed that 61 percent of accountable care organization (ACO) contracts are upside risk-only, indicating that ACOs may be risk-adverse or are still in the experimental stage with financial risk. Even though ACOs...

Premier Medicare ACOs Outperform Peers in Cost, Quality By 2:1

by Jacqueline Belliveau

Medicare accountable care organizations (ACOs) that are part of Premier Inc.’s Population Health Management Collaborative (PHMC) outperformed other Medicare Shared Savings Program (MSSP) and Pioneer ACOs in earning shared savings and improving...

House Reps Introduce Medicare ACO Improvement Legislation

by Jacqueline Belliveau

House representatives Diane Black (R-TN) and Peter Welch (D-VT) introduced a bill last week that would change the rules for Medicare accountable care organizations (ACOs). The ACO Improvement Act of 2016 contains reforms for Medicare Shared Savings...

Challenges, Successes of First-Year Shared Savings ACOs

by Jacqueline Belliveau

Participants in the Medicare Shared Savings Program (MSSP) already familiar with physician practice transformation were more likely to earn shared savings payments, which should lead the Centers for Medicare & Medicaid Services to focus on...

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