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

Medicare Shared Savings Program

Medicare Spending Greater on Patients in Downside Risk MSSP ACOs

May 29, 2018 - Moving accountable care organizations (ACOs) to Medicare Shared Savings Program (MSSP) tracks with downside financial risk may not help the accountable care initiative generate savings, according to a new analysis from the Center for Healthcare Quality and Payment Reform (CHQPR). The study found that CMS spends more per beneficiary in ACOs with downside risk compared to organizations...The federal agency also spent significantly more on beneficiaries attributed to Pioneer ACOs. Actual spending per beneficiary reached slightly over $12,250 in 2016. The Pioneer ACO model concluded at the end of that year. MSSP ACOs assuming downside risk in 2016 produced greater savings even though CMS spent more on their attributed patients because the organizations delivered more...Actual spending per beneficiary was also significantly higher compared to MSSP ACOs with upside-only risk. Average Medicare spending per beneficiary was even lower in the 186 Track 1 ACOs that spent more than their financial benchmark. CHQPR researchers argued that Track 1 ACOs that spent over their financial benchmark actually delivered the highest value care since average quality...Rather than require MSSP ACOs to assume downside financial risk, CHQPR researchers suggested that CMS consider the following options: While CHQPR offered MSSP improvements, the researchers ultimately advised CMS to drop the shared savings payment model of the MSSP in favor or a patient-centered alternative payment model (APM). The Patient-Centered APM created by the CHQPR allows a team of providers to coordinate care for individual patients. The team would agree to be held accountable for the feasible outcomes of...


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House Reps Want to Extend MSSP Track 1 ACO Participation

by Jacqueline LaPointe

Seven House Representatives are calling on CMS to allow successful accountable care organizations (ACOs) in the Medicare Shared Savings Program’s (MSSP) Track 1 to continue in the upside-only financial risk track for a third agreement...

71% of MSSP ACOs Likely to Quit Rather Than Assume Downside Risk

by Jacqueline LaPointe

The Medicare Shared Savings Program (MSSP) is requiring the 82 accountable care organizations (ACOs) that started in upside-only financial risk tracks in 2012 or 2013 to take on downside financial risk by 2019. However, the majority of thes...“The challenges to assuming risk are not surprising and highlight that CMS needs to face the reality about how the majority of ACOs view risk,” Gaus commented. “ACOs need to gain confidence through successful performance i...

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

by Jacqueline LaPointe

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...But gathering the data needed to understand a patient’s care is just the first step. “We have copious amounts of data that we have to put into a single platform and be able to actually understand and to drive results from,&rdquo...

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

by Jacqueline LaPointe

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 r...The federal agency should also consider allowing cost-efficient Track 1 ACOs to qualify for an additional non-risk-bearing agreement period. ACOs with spending lower than that of their region already face lower starting benchmarks than thei...

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

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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 ...The organizations would have earned a total of $966 million in net payments by participating in Track 1+, which was more than Avalere projected in a 2017 simulation that moved MSSP Track 1 ACOs to Track 2. In the 2016 simulation, the consul...However, nearly three-quarters of the organizations that had to repay their shared losses would have offset their financial setback with the Advanced APM incentive payment. The Advanced APM incentive payment should be an effective tool for ...

MSSP Accountable Care Organizations Moving to Risk in 2018

by Jacqueline LaPointe

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...

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

by Jacqueline LaPointe

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 hu...

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

by Jacqueline LaPointe

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 A...Furthermore, differential decreases in spending among ACOs joining the MSSP in 2013 primarily stemmed from cost savings for low-risk patients. “While targeted efforts to enhance outpatient and preventive care for high-risk patients mi...ACOs in the 2013 and 2014 MSSP cohorts did not experience changes in patients hospitalized for the studied conditions. “These findings are consistent with care coordination and management efforts, on average, either having minimal eff...

MSSP ACOs Improve Care Quality, Struggle to Realize Savings

by Jacqueline LaPointe

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 blo...“Consistent with prior years, there was little relationship between net spending and quality,” wrote researchers from the Duke-Margolis Center for Health Policy, Leavitt Partners, and Health Care Payment Learning and Action Netw...More experienced ACOs also generated net savings per beneficiary, which is the benchmark level less expenditures and any bonuses. The most mature ACOs produced net savings of $140 per beneficiary. Researchers also pointed out that quality p...Physician-led MSSP ACOs were also the only ACO type to produce net savings per beneficiary. The organizations generated $50 in net savings per beneficiary versus net losses of $65 per beneficiary for hospital-led ACOs and $13 per beneficiar...

Accountable Care Organizations Cut Medicare Spending by $836M

by Jacqueline LaPointe

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 ...

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

by Jacqueline LaPointe

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 ...In the first year, the net spending reduction totaled $234 million and increased to $429 million by the third year. With overall spending declines, about one-third of MSSP ACOs earned shared savings payments in at least one year of particip...A greater portion of ACOs also earned quality scores of 90 or above as the program matured, with 29 percent achieving at least a 90 in 2014 to 74 percent by 2015. Notably, the ACOs advanced their scores on about 82 percent of quality measur...High-performing ACOs notably decreased spending in inpatient hospital and skilled nursing facility care. Spending on inpatient hospital care dropped from $3,872 per beneficiary in 2010 to $3,324 by 2015. Other ACOs only reduced their spendi...

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

by Jacqueline LaPointe

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,...

AHA to IRS: Foster Hospital Participation in Commercial ACOs

by Jacqueline LaPointe

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) wi...

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

by Jacqueline LaPointe

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 comprom...

CMS Releases MSSP Track 1+ Model Risk Structures, Eligibility

by Jacqueline LaPointe

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 announce...If a MSSP Track 1+ ACO does not meet any of the criteria, then the ACO’s loss sharing limit will be revenue-based. For the first year, the limit will be 8 percent of the ACO participant Medicare fee-for-service revenue, including tota...

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

by Jacqueline LaPointe

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 ...

How Palliative Care Can Maximize Value-Based Reimbursement

by Jacqueline LaPointe

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 C...

61% of ACO Contracts Only Include Upside Financial Risk

by Jacqueline LaPointe

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 A...

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