This week, the National Association of Accountable Care Organizations lent its congratulations to new ACOs that joined the Medicare Shared Savings Program effective July 1.
About 40 new ACOs entered the program, which is less than the 100-plus new ACOs the program averaged in its first seven years. With the 2019 class, the MSSP grew by 400,000 beneficiaries, while prior years have seen growth of more than a million beneficiaries each year.
The next opportunity to join will be in January 2020 when the program returns to its typical schedule of ACOs joining at the start of the calendar year. The MSSP is the largest value-based payment program operated by the Centers for Medicare and Medicaid Services, and program results have steadily improved in recent years.
WHAT'S THE IMPACT
CMS made significant changes to the ACO program last year, a number of which were met with concern by the ACO industry, such as reduced shared savings opportunities and a faster pace to risk.
The new "Pathways to Success" program structure is in place as of this month, though existing ACOs had the option to complete their current agreement periods under the previous rules before shifting to the new program structure. Overall, 518 ACOs are now in the MSSP, compared to 561 last year.
Data increasingly shows ACOs are reducing Medicare spending. Earlier this month, the Medicare Payment Advisory Commission reported MSSP reduced spending between 1 and 2 percent from 2013 to 2016, which translates into tens of billions of dollars when compounded annually.
An independent analysis commissioned by NAACOS and conducted last year by a health economics and policy consulting firm showed $2.7 billion in overall savings and more than $660 million in net savings, after paying shared savings to ACOs.
Data from 2017, the most recent available, show ACO saved $1.1 billion compared to their CMS-set spending targets, a crude measure that undervalues ACO savings.
THE LARGER TREND
Last year CMS published a nearly 267-page rule overhauling the Medicare Shared Savings Program and on December 21 finalized the Pathways to Success rule. NAACOS said at the time it was concerned the changes would limit interest in the voluntary program, cause existing ACOs to drop out and harm Medicare's largest value-based care program.
ON THE RECORD
"This is a pivotal time for the transition to value, and we need to accelerate ACO adoption to effectively bend the Medicare cost curve," said Clif Gaus, NAACOS president and CEO. "We hope this smaller class is only a reflection of an off-cycle start date and not an indication that the program and transition to value are slowing down."
"Returning ACOs should be congratulated for their commitment to value-based care," he said. "But NAACOS' concern last year dealt largely with the pipeline of new ACOs, which today's participation numbers call into question. This slowing growth will shrink the pool of future, risk-taking ACOs, which CMS should concern itself with."