ACOs may participate in the Medicare Shared Savings Program (MSSP), also known as the Pioneer Model. The MSSP program contains two tracks: track 1 is a sharing-only arrangement, while track 2 puts providers at risk for increased costs.
Full Answer
What is a shared savings ACO?
Accountable Care Organizations The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high quality care to their Medicare beneficiaries. To learn more about ACOs, visit the Accountable Care Organizations webpage.
Do Accountable Care Organizations (ACOs) save Medicare money?
The Affordable Care Act Accountable Care Organizations and the Medicare Shared Savings Program. Despite this in 2013, ACOs were projected to save Medicare up to $940 million in the first four years. MSSP and ACOS are part of an overall focus on quality over quantity in order to reduce Medicare spending.
What is a shared savings program under Medicare?
Medicare shared savings program. Rewards Accountable Care Organizations (ACOs) that take responsibility for the costs and quality of care received by their patient panel over time. ACOs can include groups of health care providers (including physician groups, hospitals, nurse practitioners and physician assistants, and others).
What is an ACO?
Account Care Organizations (ACOs) are groups of medical providers that accept payments based on quality under the Medicare Shared Savings Program (MSSP).
What is a Medicare Shared savings Program ACO?
Accountable Care Organizations The Shared Savings Program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO to give coordinated, high quality care to their Medicare beneficiaries.
What is the purpose of ACOs?
What is an ACO? ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
What are ACO requirements?
An ACO must maintain an identifiable governing body with authority to execute the functions of an ACO, including but not limited to, promoting evidence-based medicine and patient engagement, reporting on quality and cost measures, and coordination of care.
Which of the following best describes the underlying mechanism driving ACOs?
Which of the following best describes the underlying mechanism driving ACOs? A fee-for-service payment model enhanced by bonus payments for controlling costs and achieving quality standards.
What are the benefits of ACOs for patients?
BenefitsImproved population health. One fundamental goal of ACOs is that they will improve the health and wellness of a defined population for which the ACO is accountable. ... Improved patient quality of care. ... A focus on the patient. ... Physician leadership. ... Lower costs. ... Shared savings.
What is an accountable care organization ACO quizlet?
what is an accountable care organization. a group of health care providers who aggree to share responsibility for the quality cost and coordination of care for a defined population of patients.
How does Medicare determine which patients will be assigned to the ACO?
Beneficiaries will be assigned to an ACO, in a two step process, if they receive at least one primary care service from a physician within the ACO: The first step assigns a beneficiary to an ACO if the beneficiary receives the plurality of his or her primary care services from primary care physicians within the ACO.
What are ACO and describe the payment models?
The Advance Payment Model was designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the Medicare patients they serve.
What are the three types of accountable care organizations?
Medicare offers three main participation options, including the Medicare Shared Savings Program (MSSP), the Pioneer ACO Model, and the Next Generation ACO Model. Several of the available pathways within these models count as Alternative Payment Models (APMs) under the Quality Payment Program.
Are ACOs effective?
Reviewing the first three years of the Shared Savings Program, the study found that the 428 participating ACOs improved performance on 82 percent of individual quality measures while serving 9.7 million beneficiaries. The ACOs also outperformed fee-for-service providers on 81 percent of the quality measures.
How do ACOs reduce cost?
By performing more outpatient and fewer inpatient procedures and by more efficiently delivering inpatient surgical care, ACOs can reduce surgical spending at a population level. Early data suggest considerable variation in the number of surgeons participating in Medicare Shared Savings Program ACOs.
Which problems would accountable care organizations ACO solve?
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.
For Accountable Care Organizations
Find information about the Shared Savings Program application process, program participation, financial benchmarking, quality reporting, and more. Learn more >
For Providers
Find information about eligibility requirements, locating Accountable Care Organizations (ACOs) in your area, and coordinating care as an ACO provider. Learn more >
Program Data
Find publicly available datasets related to ACO participation and performance. Learn more >
Program Guidance & Specifications
Find guidance and specification documents relevant to the application process and program participation. Learn more >
Program Statutes & Regulations
Find final rules, program statutes, and other regulatory documents for the Shared Savings Program. Learn more >
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.
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.
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:
What is track 1 in ACO?
It can only benefit from the shared savings that are generated. Track 1 is often viewed as a stepping stone to help the ACO ‘test the waters’ and initiate best practices and integration necessary to achieve and sustain lower costs. Savings are limited to a maximum of 50% each year.
How much Medicare Part B do you have to pay for incentive payments?
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.
How many lives are required to form an ACO?
ACO formation requires a minimum of 5,000 covered lives; however, small practices can often convene to form an ACO.
Is an ACO higher than MSSP?
In other words, the ACO’s actual costs will be higher than the anticipated ones. Without complete and accurate HCC capture, ACOs may not be able to stay below the MSSP benchmark even when cost reduction efforts have been maximized. Another consideration is that joining or forming an ACO may require significant costs.
What is Medicare ACO?
Medicare Shared Savings Program. The Medicare Shared Savings Program ( MSSP) is the primary Medicare ACO program . The MSSP was derived from the Physician Group Demonstration Project, which started during the George W. Bush administration, and the MSSP was permanently authorized by the Affordable Care Act.
What is NAACOS statement?
NAACOS statement on the 2019 Medicare ACO Class. NAACOS Statement on MedPAC’s June Report to Congress. NAACOS advocacy results in changes to ACO-17 quality measure for 2018. NAACOS urges CMS to make changes to scoring of ACO-17 (smoking cessation) quality measure for 2018.
What is NAACOS response to 2022?
NAACOS submits comments to CMS in response to 2022 proposed IPPS rule. NAACOS and 12 others write Congress in support of the Accountable Care In Rural America Act (H.R. 3746) One-page summary of the “Rural Glitch” issue and press release on the letter. NAACOS asks CMS to extend MSSP application deadlines.
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 co...
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…