On January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced that 100 new Accountable Care Organizations (ACO) began participating in the Medicare Shared Savings Program (MSSP). CMS also announced that 21 new providers and hospitals have signed up to participate in other ACO-focused shared savings programs, including the Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model. According to the latest figures:
- the 477 participants in these CMS programs are now located in 49 states and the District of Columbia and will serve nearly 8.9 million Medicare beneficiaries;
- there will be 434 ACOs participating in the MSSP in 2016, serving more than 7.7 million beneficiaries; and
- approximately 15,000 more physicians are now participating in the MSSP through ACOs.
Notably, 64 of the ACOs across all of these programs are in a two-sided risk-bearing track. This means that, in addition to being eligible to receive shared savings, these ACOs have put themselves on the hook to repay the government for any losses incurred if their cost-control measures are unsuccessful. The move toward two-sided risk signals progress towards the Administration’s goals to move 50% of traditional Medicare fee-for-service payments into alternative payment models that pay for quality of care rather than quantity of care by 2018.
Recent financial and performance results released by CMS demonstrate the ACOs’ success in controlling spending and improving quality. In fact, the agency paid out performance payments of more than $341 million in 2014 to reward the program participants’ achievement of these goals. As the success of the program continues, we can expect growing participation in ACO initiatives and increased pressure from CMS to move providers toward value-based payment models.