Savings or Selection? Initial Spending Reductions in the Medicare Shared Savings Program and Considerations for Reform.

The Milbank Quarterly
J Michael McWilliamsMichael E Chernew

Abstract

Policy Points Concerns have been raised about risk selection in the Medicare Shared Savings Program (MSSP). Specifically, turnover in accountable care organization (ACO) physicians and patient panels has led to concerns that ACOs may be earning shared-savings bonuses by selecting lower-risk patients or providers with lower-risk panels. We find no evidence that changes in ACO patient populations explain savings estimates from previous evaluations through 2015. We also find no evidence that ACOs systematically manipulated provider composition or billing to earn bonuses. The modest savings and lack of risk selection in the original MSSP design suggest opportunities to build on early progress. Recent program changes provide ACOs with more opportunity to select providers with lower-risk patients. Understanding the effect of these changes will be important for guiding future payment policy. The Medicare Shared Savings Program (MSSP) establishes incentives for participating accountable care organizations (ACOs) to lower spending for their attributed fee-for-service Medicare patients. Turnover in ACO physicians and patient panels has raised concerns that ACOs may be earning shared-savings bonuses by selecting lower-risk patients or pro...Continue Reading

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Citations

May 8, 2021·Journal of Healthcare Management / American College of Healthcare Executives·Brystana G KaufmanRobert Saunders
Jun 10, 2021·Health Services Research·Zirui Song
Nov 4, 2021·Stroke; a Journal of Cerebral Circulation·Kelby BrownBrystana G Kaufman

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