Each year, CMS publishes a brief, two-page report on the Medicare Shared Savings Program, its largest accountable care organization initiative. The report includes various statistics on the size and performance of the program, as well as a map showing the size of the ACO assigned beneficiary population by county.
Here are the major takeaways from the January 2018 report:
- Minimal promotion: In striking contrast with the practice of HHS under the Obama administration, which publicly celebrated the successes of the MSSP (and other value-based care initiatives of the Affordable Care Act), this recent report was posted to the CMS site without a press release and with little reference to it. Undoubtedly, this reflects the Trump administration's general opposition to the ACA and the fact that the MSSP was the lead healthcare delivery reform and value-based care initiative of the health reform law.
- Continued participation growth: The total number of MSSP ACOs is up 17 percent, from 480 in 2017 to 561 in 2018, and the number of assigned beneficiaries is also up 17 percent, from 9.0 million in 2017 to 10.5 million in 2018 — covering about 18 percent of Medicare beneficiaries.
- Maintenance of average beneficiary population size: The average number of beneficiaries per ACO remains about 19,000.
- Steadily improving quality performance: Average overall quality scores have improved for three straight years, with an excellent 94.65 percent for 2016 (the most recent performance year).
- Increasing earned performance payments: Total payments totaled over $700 million for Performance Year 2016, up for the fourth straight year, and demonstrates that the MSSP is saving Medicare money. From 2012 thru 2016, earned performance payments totaled $2.0 billion.
- More risk-taking: Saliently, the percentage of MSSP ACOs under risk-based contracts has doubled from 9 percent in 2017 to 18 percent in 2018. This is a major positive development.
- Significant hospital participation: Over 1,500 hospitals — about 30 percent of the nation's acute care facilities — are participating in the MSSP. This indicates that so-called "slow followers" are getting on the ACO train.
Conclusion
Despite the lack of fanfare, the latest MSSP report's generally positive results indicate that ACOs clearly remain the biggest value-based care initiative of the federal government. Despite opposition to the ACA in general by congressional Republicans and the Trump administration, given renewed concerns about the Tax Cuts and Jobs Act's adverse impact on the federal debt, look for continued support of the MSSP and other ACO programs as ways to help curb growth of the nation's healthcare spending, which is a bipartisan objective.