Medicare ACOs vary in how they spend savings, though many aren't reporting plans, study finds

A new report published in the American Journal of Managed Care found that just over half of MSSP ACOs shared plans on how they'll allocate savings.

While accountable care organizations in Medicare's Shared Savings Program must publicly show not only the amount of savings they generate, but what they also plan to do with the cash, a new report published in the American Journal of Managed Care found that just over half of ACOs shared plans on how they'll allocate savings.

At the same time, how ACOs spend their surpluses varies.

According to researchers John Schulz, Matthew DeCamp, MD, and Scott A. Berkowitz, MD, of the 52 percent of ACOs that detailed spending plans on their websites, 63 percent said they would give the savings to their member primary care providers, specialists or hospitals. Meanwhile, 33 percent said they would spend that savings on infrastructure.

[Also: ACOs mixed on Medicare Shared Savings Program final rule]

The authors also said ACOs that included a hospital planned to give more to participating entities than ACOs that did not include a hospital.

Rules of the MSSP require ACOs to share savings distributions, and while 52 percent reported those in detail, 84 percent at least offered some information about savings distribution, even though those were vague in some cases, the authors said.

"There are several possible explanations for this finding," the authors said. "First, all of the ACOs without a website were in the January 2014 start date, and these ACOs might have created websites since the study was conducted mid-year, or the websites existed but were unable to be found with normal search functions. Second, since initial public reporting guidance was issued in 2012, CMS has issued updated guidance in September 2014 that explicitly clarifies that ACOs must adhere to the reporting format of CMS."

The authors pulled the information from the websites of all 338 MSSP ACOs launched through January 2014.

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For 2012-2013, participating ACOs generated a combined $383 million in savings to Medicare, with the 52 highest performing ACOs generating $315 million of those savings.

The Centers for Medicare and Medicaid Services has not yet released data on 2014 performance, but those results could come this month.

The extra transparency in requiring participating ACOs to disclose savings distribution plans gives patients an opportunity to see if those dollars are being used to directly affect them in the form of new programs or indirectly by supporting physician development or infrastructure, the authors wrote. At the same time, policy makers could use the results to better understand where ACOs see the biggest drivers of their successes.

Ultimately, the authors said research should continue as the program matures to be able to tell which plans for spending shared savings better benefit the ACOs.

"There appears to be no single shared savings distribution plan determinate of ACO success," they said. "Continued investigation of predictors for generating savings is needed to inform future shared savings models."

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