Changes in Medicare Shared Savings Program Savings From 2013 to 2014
J. Michael McWilliams, MD, PhD1
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
JAMA. Published online September 09, 2016. doi:10.1001/jama.2016.12049
"In the Medicare Shared Savings Program (MSSP), participating accountable care organizations (ACOs) are eligible for shared-savings bonuses from the Centers for Medicare & Medicaid Services (CMS) if spending for their patient population falls below a financial benchmark. In 2013, the first full year of the MSSP, modest spending reductions were entirely offset by bonus payments.1 Program savings beyond 2013 have not been formally evaluated." (McWilliams, 2016)
DISCUSSION
"By 2014, spending reductions in the MSSP exceeded bonus payments, suggesting that shared-savings contracts without downside risk for excess spending—in which 95% of MSSP ACOs currently participate—may be a fiscally viable alternative payment model for Medicare. The growth in MSSP savings suggests continued growth may be possible, particularly if incentives for ACOs to lower spending are strengthened,1,3,4 though results may not generalize to future years and cohorts. Findings from subgroup analyses suggest that physician-hospital integration is unnecessary for ACO success and that CMS’s plan to lower benchmarks for ACOs with high spending toward a regional average should proceed cautiously, lest the MSSP lose its most valuable participants." (McWilliams, 2016) 5,6
ARTICLE INFORMATION
Section Editor: Jody W. Zylke, MD, Deputy Editor.
Corresponding Author:J. Michael McWilliams, MD, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (mcwilliams@hcp.med.harvard.edu).
Conflict of Interest Disclosures:Dr McWilliams has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and he reports serving as a consultant to Abt Associates in an evaluation of the ACO Investment Model and as an expert witness to the Federal Trade Commission.
Funding/Support: This work was supported by grant P01 AG032952 from the National Institute on Aging of the National Institutes of Health (NIH).
Role of the Funder/Sponsor: The funder played no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Additional Contributions:The author thanks Pasha Hamed, MA, for statistical programming support and Jesse B. Dalton, MA (both from Department of Health Care Policy at Harvard Medical School), for research assistance. They were supported by the funding source and received no additional compensation.
Disclaimer:The content is solely the responsibility of the author and does not necessarily represent the official views of the NIH.
McWilliams JM, Hatfield LA, Chernew ME, et al. Early performance of accountable care organizations in Medicare. N Engl J Med. 2016;374(24):2357-2366. PubMed | Link to Article
Douven R, McGuire TG, McWilliams JM. Avoiding unintended incentives in ACO payment models. Health Aff (Millwood). 2015;34(1):143-149. PubMed | Link to Article
McWilliams JM, Chernew ME, Dalton JB, Landon BE. Outpatient care patterns and organizational accountability in Medicare. JAMA Intern Med. 2014;174(6):938-945. PubMed | Link to Article
Rose S, Zaslavsky AM, McWilliams JM. Variation in accountable care organization spending and sensitivity to risk adjustment. Health Aff (Millwood). 2016;35(3):440-448. PubMed | Link to Article