What is the intent of an ACO?
The purpose of an ACO is to enable care coordination that allows a patient to receive the right care at the right time while reducing the risk of medical errors and duplicate services.
Is ACO an effective method to save money for Medicare?
“Accountable Care Organizations are an Affordable Care Act success story,” said CMS Administrator Chiquita Brooks-LaSure. “The 2020 Shared Savings Program results continue to demonstrate the impact ACOs have in improving quality and lowering health care costs.Aug 25, 2021
What is the difference between an ACO and MSSP?
The Pioneer ACO model was the framework for the Next Generation ACO model. The MSSP is a permanent ACO program in traditional Medicare that provides financial incentives for meeting or exceeding savings targets and quality goals.
What are the pros and cons of accountable care organizations?
The Pros and Cons of Accountable Care OrganizationsThe Value-Based Payment Structure. ... 3 Key Needs of Accountable Care Organizations. ... Bonus payments can be significant. ... ACOs bring practices closer to patient-centered care. ... ACOs provide better quality care at a lower cost. ... ACOs support independent practice.More items...
What are the disadvantages of an ACO?
Cons. Limited choice: With so many healthcare providers joining ACOs, some patients will have trouble finding doctors outside of a specific group. The shortage of options could lead to higher patient costs. Referral restrictions: ACOs provide doctors incentives to refer to specialists within the group.
Which problems would accountable care organizations ACO solve?
Background. Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs.Feb 5, 2016
What is a pioneer ACO?
The Pioneer ACO Model is an initiative launched by the Centers for Medicare & Medicaid Services (CMS) Innovation Center that is designed 1) to show how particular ACO payment arrangements can best improve care and generating savings for Medicare; and 2) to test alternative program designs to inform future rulemaking ...
Is MSSP fee-for-service?
The Affordable Care Act (ACA) established the Medicare Shared Savings Program (MSSP) to facilitate coordination and cooperation among healthcare providers, in order to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs.
What is a next generation ACO?
The Next Generation ACO Model was an initiative for ACOs that were experienced in coordinating care for populations of patients. It allowed these provider groups to assume higher levels of financial risk and reward than were available under the Shared Savings Program (MSSP).
How do ACOs make money?
At the base of the ACO payment structure are incentive payments. Providers in the ACO receive fee-for-service payments throughout the performance period. At the end of the period, payers adjust the payments based on the ACO's quality performance on specified metrics.Apr 5, 2019
How do ACOs benefit patients?
ACOs are structured to create an incentive to be more efficient by offering bonuses when providers keep costs down. They must carefully manage consumers with chronic conditions, focusing on prevention, to impact utilization of services and reduce overall costs of care.May 13, 2021
Is ACO better than PPO?
“The bottom line: ACOs show similar performance compared to HMO provider networks on both clinical quality and total cost of care, and better performance compared to PPO provider networks,” researchers highlighted. The findings may push the ACO model ahead of the HMO.Jun 3, 2019
What is MSSP in healthcare?
Medicare Shared Savings Program (MSSP) Provide high-quality, coordinated care to improve outcomes and reduce costs. That’s the primary goal of the Medicare Shared Savings Program (MSSP). The MSSP is an alternative payment model in which eligible providers, hospitals, and suppliers are rewarded for achieving better health for individuals, ...
What is ACO in MSSP?
Coming together to effect change. In the MSSP, teamwork is paramount. To participate, providers must be part of an Accountable Care Organization (ACO), a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending.
What is next generation ACO?
A Next Generation ACO is similar to a traditional ACO; however, participants assume a higher level of financial risk. To be eligible for incentive payments under MIPS, physicians must receive 25% of their Medicare Part B payments or see 20% of their patients through the advanced APM.
What is an ACO?
Each ACO must also create a governing body that represents providers, suppliers, and beneficiaries. An ACO is also responsible for routine self-assessment , including monitoring the care that Medicare patients receive and continually improving processes and outcomes.
How many quality measures are required for ACOs?
To be eligible for any shared savings that are generated, ACOs must also meet the established quality performance standards for 31 quality measures (29 individual measures and one composite that includes two individual component measures). These MSSP quality measures span the following four quality domains:
Can Medicare beneficiaries choose any provider?
Medicare beneficiaries can continue to choose any provider who accepts Medicare—even if that provider is not part of the ACO. However, beneficiaries benefit from seeing providers in the ACO network because these providers all have a vested interest in providing coordinated, high-quality care.
What is option 2 of the ACO?
Option 2: Two PY term + Automatic Extension Clause.The repayment mechanism covers a term of at least the first two performance years in which the ACO is participating under a two-sided model and provides for automatic, annual 12-month extensions of the repayment mechanism, such that the repayment mechanism will eventually remain in effect for the duration of the agreement period plus 12 months following the conclusion of the agreement period. Refer to 42 CFR §425.204(f)(6)(i)(B) and §425.204(f)(6)(ii)(B).
What is account fee?
Account fees or other fees associated with establishing, maintaining, or canceling a repayment mechanism are the responsibility of the ACO and should not be paid out of the principal or penal sum for the repayment mechanism.
How long does the repayment mechanism have to be in effect?
The repayment mechanism must be in effect for the duration of the ACO’s participation under atwo-sided model plus 12 months following the conclusion of the agreement period. To meet this requirement, the repayment mechanism must satisfy one of the following criteria. Refer to 42 CFR
What is a re-entering ACO?
A renewing ACO, or a re-entering ACO that is the same legal entity as an ACO that previously participated in the program, may use its existing repayment mechanism to establish its ability to repay shared losses incurred for performance years in the new agreement period, provided the ACO submits documentation establishing:
What is Medicare Shared Savings Program?
Shared-savings programs are perhaps the most advanced and most effective set of value-based payment programs that hospitals can participate in today. The Medicare Shared Savings Program (MSSP) is designed to provide high-quality, coordinated care to improve outcomes and reduce costs.
How many Medicare beneficiaries are covered by ACOs?
Introduced in 2012, the Medicare Shared Savings Program (MSSP) is a voluntary program established by the Affordable Care Act. At present, over 7.7 million Medicare beneficiaries are covered by ACOs.
How are ACOs paid?
ACOs are paid through shared-savings contracts, which are similar to bundled-payment contracts. The major difference between them is that payment under bundled-payment contracts is for an episode of care for a single patient, but payment under shared-savings contracts is for the total cost of care for a given population across a given period, ...
How does Medicare share savings work?
How does the revised Medicare Shared Savings Program work? 1 Promote beneficiary engagement by offering incentives to maintain good health 2 Develop a method for linking quality and financial performance and report regularly on both quality and cost 3 Provide coordinated care within the ACO
What is MSSP in healthcare?
The MSSP is open to qualifying Accountable Care Organizations (ACOs), which are groups of healthcare stakeholders that have reimbursement tied to quality and cost metrics. Under the MSSP, participating ACOs receive incentive payments for meeting certain benchmarks each year. The MSSP is a type of Alternative Payment Model (APM) ...
Can Medicare beneficiaries choose any provider?
Medicare beneficiaries can choose any Medicare-enrolled provider they wish, regardless of MSSP participation. Hospitals and physicians that participate in the MSSP are motivated to provide quality, coordinated care without excessive cost.
What is the NAACOS program?
The National Association of ACOs (NAACOS) sees several positive outcomes of the MSSP’s Pathways to Success. Longer agreement periods promote stability and predictability. The new program also allows for more gradual increases in risk than the previous model.
Can an ACO participate in MSSP?
If your organization is part of an ACO, it can participate in the MSSP. The MSSP encourages physicians, medical groups and other providers to join forces to form ACOs. Participating ACOs agree to be held accountable for assigned Medicare fee-for-service beneficiaries.
What is shared savings?
The “Shared Savings” part of the program relates to incentives , and the CMS sets a number of benchmarks. Organizations receive money when they reduce expenditures based on the CMS’ cost and quality benchmarks. For Track 1, you receive 50 percent of all generated savings. This increases to 60 percent on Track 2 and 75 percent on Track 3.
What is MSSP in healthcare?
The MSSP consists of three tracks, and the incentives vary across the trio. Providers willing to take more risk are capable of gaining greater rewards. Beneficiary assignment dictates who becomes an ACO patient and decides how much an organization earns.
What is the key tenet of MSSP?
The key tenet of the MSSP is the use of quality performance measures by ACOs. It is certainly a tricky task as providers are expected to link financial performance with quality. The CMS says that quality measures must focus on continuous improvement, and it revolves around these three goals:
What are the measures of clinical quality?
There are 33 measures used to measure clinical quality, and they include four sections: 1 Preventive Health 2 At-risk Populations 3 Patient and Caregiver Experience 4 Care Coordination and Patient Safety
What is shared savings program?
Under the Shared Savings Program, the ACO providers and suppliers will continue to be paid for services rendered to fee-for-service Medicare beneficiaries in the same manner as they would otherwise. In addition, the participating ACO will be eligible to receive a shared savings payment if the ACO meets the quality performance standards and has generated shareable savings under the performance-based payment methodology described in the rule.
What is Medicare ACO?
20, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), finalized new rules under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program (Shared Savings Program) will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Provider participation in an ACO is purely voluntary.
Medicare Shared Savings Program
Coming Together to Effect Change
- In the MSSP, teamwork is paramount. To participate, providers must be part of an Accountable Care Organization (ACO), a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending. The MSSP requires ACOs to promote evidence-based medicine, engage beneficiaries, report internall…
Financial Risk and The MSSP
- To understand truly understand the role of ACOs in the MSSP, one must understand the concept of financial risk. It’s the idea that ACOs in the MSSP can—and should—take on some degree of responsibility for lowering costs (i.e., ensuring that actual expenditures don’t exceed updated historical benchmark data). When they don’t accomplish this goal, they may be penalized. Howe…
Quality and The MSSP
- To be eligible for any shared savings that are generated, ACOs must also meet the established quality performance standards for 31 quality measures(29 individual measures and one composite that includes two individual component measures). These MSSP quality measures span the following four quality domains: 1. Patient/caregiver experience 2. Care coordination/pa…
The MSSP from The Beneficiary’S Perspective
- Medicare beneficiaries can continue to choose any provider who accepts Medicare—even if that provider is not part of the ACO. However, beneficiaries benefit from seeing providers in the ACO network because these providers all have a vested interest in providing coordinated, high-quality care.
Important Considerations in The MSSP
- There are several other important concepts to consider when joining an ACO as part of the MSSP. The article, What is an Accountable Care Organization (ACO), provides great insights into some overlying concerns with ACOs today. “Since the inception of ACOs in 2012, many are reaching the limit of their no-risk contracts and are considering whether they want to continue with the Medic…