Medicare Shared Savings saved Medicare $1.8 billion in 2022
ACOs that earned shared savings tended to be low revenue small and rural hospitals or organizations made up of physicians.
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The Medicare Shared Savings Program saved Medicare $1.8 billion in 2022 compared to spending targets for that year, the Centers for Medicare and Medicaid Services has announced.
This represents the second-highest annual savings accrued for Medicare since the program's inception more than 10 years ago and marks the sixth consecutive year the program has generated overall savings and high-quality performance results, CMS said.
WHY THIS MATTERS
Accountable Care Organizations in the program share in the savings and earn performance payments when spending is cut. CMS has released performance data.
Of the 482 accountable care organizations in 2022, 84% achieved savings to Medicare and 63% earned shared savings, according to CMS and the National Association of ACOs. MSSP actually saved Medicare $4.3 billion, with the savings of $1.8 billion reported after accounting for shared savings and losses, according to NAACOS.
For example, in 2022, Trinity Health Integrated Care ACO said it saved Medicare $56 million, with earned shared savings of $41.2 million.
An estimated $644 million was paid in incentives this year, NAACOS said, adding these incentives are critical in helping clinicians cover the investment costs of moving to new payment models.
An interesting factor is that 63% of ACOs earning payments for their performance tended to be low revenue, according to CMS. Low-revenue ACOs are usually those mainly made up of physicians, and may include a small or rural hospital.
Performance results show that with $228 per capita in net savings, low-revenue ACOs led high-revenue ACOs, who had $140 per capita net savings. Low-revenue ACOs comprised of 75% primary care clinicians or more saw $294 per capita in net savings.
Susan Dentzer, America's Physician Groups president and CEO, said, "These important results for 2022 underscore the fact that the ACOs that scored the highest per capita savings have been led by physicians."
THE LARGER TREND
ACOs have generated more than $21 billion in gross savings for Medicare over the last decade. More than 700,000 physicians and other non-physicians participate in Medicare ACOs, caring for more than 13 million beneficiaries, making it the largest alternative payment model in Medicare.
Based on the program's success, CMS has set a goal that 100% percent of people with Traditional Medicare will be part of an accountable care relationship by 2030.
Shared Savings Program Accountable Care Organizations are groups of doctors, hospitals and other healthcare providers who collaborate and provide coordinated, high-quality care to people with Medicare while avoiding unnecessary services and medical errors.
Medicare beneficiaries in ACOs see lower out-of-pocket spending on avoidable healthcare utilization such as emergency department visits, CMS said.
ACOs report higher performance than non-ACOs on quality measures related to diabetes and blood pressure control; breast cancer and colorectal cancer screening; tobacco screening and smoking cessation; and depression screening and follow-up, according to CMS.
CMS's Innovation Center continues to explore testing models and features to support Shared Savings Program ACOs in increasing investment in primary care services.
Earlier this year, in the 2024 Physician Fee Schedule proposed rule, CMS proposed changes to the Medicare Shared Savings Program to promote participation among healthcare providers and promote equity, especially in rural and underserved areas.
In particular, CMS proposes assigning more people who receive care from nurse practitioners, physician assistants, and clinical nurse specialists to ACOs.
In addition, CMS proposes changes to the benchmark methodology to encourage participation by ACOs caring for medically complex, high-cost beneficiaries to join the program.
Public comment on the Physician Fee Schedule proposed rule is due by September 11.
Congress should encourage participation in ACOs and other value-based care models by extending incentive payments for taking risk-bearing ACOs, said NAACOS, which supports the Value in Health Care Act to extend incentives that expire at the end of the year.
ON THE RECORD
"We are encouraged and inspired by six consecutive years of savings and high-quality care, with 2022 being one of the strongest years of performance to date," said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare. "The Shared Savings Program is Medicare's permanent, flagship Accountable Care Program, and we look forward to continually improving and growing the program, expanding the reach of participating ACOs, and addressing critical health disparities across the country."
"Every year, the body of data on how ACOs are improving our fragmented health system grows, and this year is no different," said Clif Gaus, president and CEO of NAACOS. "ACOs continue to provide more of what patients want and deserve -- affordable, high-quality, coordinated, and personalized care."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
