ACO Enrollment in MSSP Stalls

Gianna Melillo

Accountable care organization (ACO) participation in the Medicare Shared Savings Program (MSSP) remained flat this year, according to a press release from the National Association of Accountable Care Organizations (NAACOS) issued Friday, January 10.

From 2012 to 2018, MSSP saw an average of 107 newly enrolled ACOs each year. In 2019, only 41 new ACOs joined the program. And in 2020, that number fell to 35 Shared Savings Program ACOs entering into their first contract with CMS.

MSSP is the country’s main value-based payment program. Recent stagnant enrollment rates are accredited to changes in CMS enacted in 2018.

“In the fall of 2018, CMS overhauled the Shared Savings Program to force ACOs to take on risk sooner while at the same time reducing the portion of savings ACOs can keep,” the press release read. “NAACOS and other health provider associations warned the changes could harm Medicare’s move to value-based payment by hindering participation in a voluntary program.”

Overall, 11.2 million patients, the highest number ever reported, are being cared for by ACOs in 2020.

“The ACO model spurs coordinated care for physicians and hospitals to work together to improve outcomes and to lower costs. Providers can earn back part of the savings they generate for Medicare by hitting predetermined spending goals. Now they are being required to also take risk,” said an article in Healthcare Finance.

Clif Gaus, president and CEO of NAACOS, said of the decline, “ACOs have had the greatest success of any of Medicare’s payment reform efforts. If interest in ACOs dwindles, then doctors and hospitals will fall back into a fragmented, fee-for-service system and any momentum to transform our health system will be lost.”

In 2018, ACOs collectively saved Medicare $1.7 billion, as well as $739 million due to shared savings bonuses and shared loss payments, according to previously reported data.

In addition, the Medicare Payment Advisory Commission reported that last year, “MSSP reduced spending between 1% and 2% from 2013 to 2016, which translates into tens of billions of dollars when compounded annually.” An independent analysis “showed $3.53 billion in overall savings and more than $755 million in net savings after paying shared savings to ACOs.”

Because MSSPs are so critical to the success of a value-based care model, reduced ACO enrollment could be a major impediment to the model’s implementation.

The press release also noted that the Next Generation ACO model (Next Gen), Medicare’s most advanced and greatest risk-taking ACO, “collectively saved Medicare $406 million last year…After accounting for shared savings paid to ACOs for holding down costs and hitting quality targets as well as shared losses paid back to the government, the Next Gen program netted $185 million to Medicare last year alone.”

The program is scheduled to sunset at the end of 2020, but advocates, including NAACOS, have called on CMS to make the program permanent. They argue it will serve as “an additional option when contemplating participation in direct contracting and other ACO models in 2021 and beyond.”

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