An independent analysis found Medicare Shared Savings Program ACOs generated $1.84 billion in gross savings from 2013 to 2015 — nearly twice as much as the CMS estimate of $954 million.
The analysis, conducted by Washington, D.C.-based consulting firm Dobson DaVanzo & Associates, was commissioned by the National Association of ACOs and published Sept. 11. Dobson DaVanzo found ACOs reduced federal spending by $541.7 million between 2013 and 2015, after accounting for shared savings. CMS estimated ACOs increased federal spending by $344 million during this period.
The difference in estimates stems from methodology, according to the Dobson DaVanzo report. The consultancy conducted a "difference-in-difference regression" analysis using data from roughly 25 million Medicare patients per year. It compared claims from patients who were part of an ACO with those of fee-for-service patients during the same period. Their analysis answered the question: "How have ACOs changed expenditures compared to providers not participating in the ACO program?"
CMS used a benchmarking approach, which compares ACOs' actual spending to what their spending would have been without the program. This target was found using historical spending and trending it forward with the national average growth rate in Medicare spending. Dobson DaVanzo characterized the CMS analysis as answering the question: "How has ACO spending changed compared to prior years' spending?"
Dobson DaVanzo concludes the CMS estimates are not accurate reflections of the program's progress and incorrectly inform policymaking. NAACOS, the group that commissioned the study, has testified against proposed policy changes that would push MSSP ACOs to take on risk sooner.
"The analysis should put to rest claims that shared savings-only ACOs do not save Medicare money," NAACOS President and CEO Clif Gaus, ScD, said in a press release. "The findings confirm the wisdom of giving ACOs adequate time to build the care coordination, information technology and data analytics capabilities needed to manage financial risk successfully."
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