Public Payers News

Where the Medicare Shared Savings Program May be Lacking

CMS could make improvements to the Medicare Shared Savings Program by bringing more focus toward primary care.

By Vera Gruessner

The latest news from the Medicare Shared Savings Program and its associated accountable care organizations shows that some goals of the project have been gained such as ongoing cost savings and quality performance benchmarks. However, there are still some areas in which the Medicare Shared Savings Program could improve.

Accountable Care Organizations

While the Medicare Shared Savings Program has saved as much as $466 million in 2015, the Centers for Medicare & Medicaid Services (CMS) could improve upon the program by supporting primary care among accountable care organizations, according to the American Academy of Family Physicians (AAFP).

Robert L. Wergin, MD, Board Chair of the AAFP, had sent a letter this past Spring to CMS Acting Administrator Andy Slavitt in which he argues for moving beyond calculating spending and cost savings based on historical expenditure. Wergin claims that calculating spending based on average regional expenditures would be more beneficial for accountable care organizations.

Additionally, the American Academy of Family Physicians has stated that bringing speedier sharing of data among primary care practices will enable smaller physician offices to participate in accountable care and the Medicare Shared Savings Program.

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  • Wergin went on to explain that patients who are assigned to accountable care organizations should be given more priority when a physician has treated them for a longer period of time instead of a more recent, solitary visit. This would, once again, stress the need for primary care support within the Medicare Shared Savings Program.

    While there may need to be more focus on supporting primary care among ACOs, the Medicare Shared Savings Program has brought more than $1.29 billion in savings since 2012, CMS reported in a press release.

    More than 400 accountable care organizations have been participating in the Medicare Shared Savings Program and the number of ACOs only continues to grow in the private market as well, according to a study from Leavitt Partners and the Accountable Care Learning Collaborative.

    The results are showing that accountable care organizations with more experience tend to perform better while more savings were garnered in 2015 as compared to 2014. When it comes to metrics surrounding patient satisfaction, clinician communication, health IT use, and preventive screenings, the Pioneer Accountable Care Organization Model has shown significant improvements, reported CMS. All 12 ACOs participating in the Pioneer ACO Model achieved improved their quality scores by 21 percent from 2012 to 2015.

    Orange Accountable Care of South Florida as well as the National ACO LLC (NACO) are two ACOs that shared in cost savings last year through the Medicare Shared Savings Program.

    “Orange Accountable Care of South Florida was founded in 2014 with the intent to unite independent physicians and increase quality of care in one of the most expensive markets in the United States,” Lissette Exposito, RN, BSN, MHSA, Orange CEO and President, said in a public statement. “In our second year, we are thrilled to have ranked ninth in the country and third in the state of Florida in earned shared savings for the 2015 performance year.”

    The National ACO LLC was able to gain $6.9 million in savings for the Medicare Shared Savings Program in 2015 and nearly $15 million over the last three years.

    “As a physician owned and governed ACO that has achieved savings in 2013, 2014 and 2015, we will continue to develop, implement and refine forward-thinking and innovative programs that will lead to our goals of improving the patient’s experience of care, improving the health of populations and reducing the per capita costs of healthcare,” Alex Foxman, M.D., F.A.C.P., President, Board Member and Medical Director of National ACO, LLC, stated in a press release.

    “We are extremely thrilled to consistently generate shared savings and reward our participating providers who worked diligently to achieve the triple aim and excel in the rapid changes from volume to value-based care. We sought to achieve greater outcomes with improved efficiency, reducing costs and improving the patient’s experience and we accomplished just that,” said Andre Berger, M.D., CEO and Board Member of National ACO, LLC.

     

    Dig Deeper:

    Time, Commitment Required for ACO, Value-Based Care Success

    What Are the Benefits of Accountable Care Organizations?