In the News

Find the latest news about the Shared Savings Program and related initiatives.

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2020

December 1, 2020

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare Physician Fee Schedule final rule that includes regulatory changes to the Medicare Shared Savings Program (Shared Savings Program). A summary of those changes are as follows:

CMS finalized with modifications, our proposed revisions to the Shared Savings Program quality reporting requirements and quality performance standard for performance years beginning on January 1, 2021, to align with Meaningful Measures framework, reduce reporting burden, and focus on patient outcomes.

For Performance Year (PY) 2020, CMS finalized the proposal to waive the requirement for Accountable Care Organizations (ACOs) to field a Consumer Assessment of Healthcare Providers and Systems (CAHPS®) for ACOs survey patient experience of care surveys and ACOs will receive automatic full credit for the patient experience of care measures. For more information, please refer to the Quality Payment Program (QPP) 2021 Final Rule Zip File

In response to new telehealth code policies, and to update the definition of primary care services to reflect services for cognitive impairment and chronic care management, CMS finalized the inclusion of new evaluation and management and care management Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, including new telehealth codes, in the methodology used to assign beneficiaries to ACOs. CMS is also finalizing the proposal to exclude additional codes when delivered in skilled nursing facilities and inpatient care settings; codify the policy of adjusting an ACO’s historical benchmark to reflect any regulatory changes to the beneficiary assignment methodology; and lower required repayment mechanism amounts for certain renewing and re-entering ACOs.

In response to public comments, CMS revised the regulations specifying the adjustment to program calculations for episodes of care for treatment of the coronavirus disease 2019 (COVID-19) to ensure greater consistency in the policies used to identify inpatient services provided by inpatient prospective payment system (IPPS) and non-IPPS providers that trigger an episode of care for treatment of COVID-19. Additionally, CMS is finalizing the regulations specifying the expanded definition of primary care services for purposes of determining beneficiary assignment, and additional primary care service codes will be applied to all months of the assignment window (as defined in § 425.20) when the assignment window includes any month(s) of the COVID-19 public health emergency (PHE). For more information refer to:

September 14, 2020

PY 2019 Financial and Quality Performance Results

CMS released financial and quality performance results for PY 2019 and PY 2019A. PY 2019 includes the performance periods beginning January 1, 2019, and ending June 30, 2019, as well as the performance period beginning January 1, 2019, and ending December 31, 2019. PY 2019A refers to the performance period beginning July 1, 2019, and ending December 31, 2019.

Health Affairs Blog: 2019 Medicare Shared Savings Program ACO Performance: Lower Costs And Promising Results Under ‘Pathways To Success’

To view the complete performance results, refer to PY 2019 Performance Results and PY 2019A Performance Results.

August 4, 2020

Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

CMS is proposing changes to the Shared Savings Program quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021, to align with Meaningful Measures, reduce reporting burden and focus on patient outcomes. For PY 2020, CMS is proposing to provide automatic full credit for CAHPS patient experience of care surveys. CMS is also seeking comment on an alternative scoring methodology approach under the extreme and uncontrollable circumstances for performance year 2020. For more information, please reference the 2021 Quality Payment Program Proposed Rule Overview Fact Sheet.

In response to new telehealth code proposals and to update the definition of primary care services to reflect services for cognitive impairment and chronic care management, CMS is proposing to include new evaluation and management and care management CPT and HCPCS codes in the methodology used to assign beneficiaries to ACOs. In addition, CMS is proposing to exclude certain services furnished in skilled nursing facilities from the assignment methodology when provided by clinicians in Federal Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and to modify the definition of primary care services to exclude advance care planning CPT code 99497 and the add-on code 99498 when billed in an inpatient care setting. CMS is also codifying in regulations its policy of adjusting ACO’s historical benchmark to reflect any regulatory changes to the beneficiary assignment methodology.

As part of our efforts to reduce burden associated with repayment mechanisms, CMS is proposing to establish a policy that would allow renewing ACOs that wish to continue use of their existing repayment mechanism to decrease their repayment mechanism amount if a higher amount is not needed to support their new agreement period. This proposed approach includes a revised methodology for calculation of repayment mechanism amounts beginning with the application cycle for an agreement period starting on January 1, 2022, and in subsequent years, as well as a one-time opportunity for eligible ACOs that renewed their agreement periods beginning on July 1, 2019, or January 1, 2020, to elect to decrease the amount of their repayment mechanisms. For more information, refer to:

April 30, 2020

Interim Final Rule with Comment Released Announcing Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency

On April 30, 2020, CMS made changes to the Shared Savings Program to give the 517 ACOs serving more than 11 million beneficiaries greater financial stability and predictability during the COVID-19 pandemic. 

Because the impact of the pandemic varies across the country, CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level.

ACOs and their participating health care providers are using telehealth visits to continue to coordinate and deliver high quality care to their assigned beneficiaries. Consequently, for PY 2020 and any subsequent performance year that starts during the PHE, CMS is including additional codes within the definition of primary care services used in determining beneficiary assignment under the Shared Savings Program so CMS can appropriately assign beneficiaries to ACOs based on remotely provided primary care services.

For more information, refer to: 

January 10, 2020

New ACOs Join the Shared Savings Program 

On January 10, 2020, CMS released the ACO participation data for the 2020 performance year. 

Health Affairs Blog: Number Of ACOs Taking Downside Risk Doubles Under ‘Pathways To Success’

You can find here a full list of Shared Savings Program ACOs, including their ACO participants and skilled nursing affiliates. 

2019

September 30, 2019

PY 2018 Financial and Quality Performance Results

CMS released financial and quality performance results for PY 2018.

To view the results, refer to PY 2018 Performance Results.

July 17, 2019

New ACOs Join the Shared Savings Program

On July 17, 2019, CMS released the ACO participation data for the July 1, 2019, start date. We approved a total of 206 ACO applications for this start date, which raised the total number of Medicare fee-for-service beneficiaries who receive care from health care providers in ACOs from 10.5 million to 10.9 million.

You can find here a full list of Shared Savings Program ACOs, including their ACO participants and skilled nursing facility affiliates as of July 1, 2019.

2018

December 31, 2018

Shared Savings Program Final Rule

On December 31, 2018, CMS published a final rule that sets a new direction for the Shared Savings Program. Referred to as “Pathways to Success,” the final rule streamlines and redesigns the participation options available under the Shared Savings Program to encourage ACOs to transition to performance-based risk more gradually and incrementally to increase savings for the Trust Funds. The policies also include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018, specifically in the areas of new beneficiary incentives, telehealth services, and choice of beneficiary assignment methodology. 

For more information, refer to Federal Register December 2018 Final Rule.

November 23, 2018

Physician Fee Schedule Final Rule

The Physician Fee Schedule (PFS) final rule published in November 2018 addresses a subset of changes to the Shared Savings Program for ACOs proposed in the August 2018 proposed rule “Medicare Program; Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success” and addresses various other revisions designed to update program policies under the Shared Savings Program. In order to ensure continuity of participation, finalize time-sensitive program policy changes for currently participating ACOs, and streamline the ACO core quality measure set to reduce burden and encourage better outcomes, CMS is finalizing the following policies:

  • A voluntary 6-month extension for existing ACOs whose participation agreements expire on December 31, 2018, and the methodology for determining financial and quality performance for this 6-month performance year from January 1, 2019, through June 30, 2019.
  • Reducing the Shared Savings Program core quality measure set by eight measures; and promoting interoperability among ACO providers and suppliers by adding a new Certified EHR Technology (CEHRT) threshold criterion to determine ACOs’ eligibility for program participation and retiring the current Shared Savings Program quality measure on the percentage of eligible clinicians using CEHRT.
  • Allowing beneficiaries who voluntarily align to a Nurse Practitioner, Physician Assistant, Certified Nurse Specialist, or a physician with a specialty not used in assignment to be prospectively assigned to an ACO if the clinician they align with is participating in an ACO, as provided for in the Bipartisan Budget Act of 2018.
  • Providing relief for ACOs and their clinicians impacted by extreme and uncontrollable circumstances in 2018 and subsequent years.
  • Revising the definition of primary care services used in beneficiary assignment.

For more information, refer to Details for Calendar Year (CY) 2019 Physician Fee Schedule Final Rule.

August 9, 2018

Shared Savings Program Proposed Rule

CMS issued a proposed rule that would provide a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses). These proposed policies are designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities, and promote regulatory flexibility and free-market principles. The proposed rule also would provide new tools to support coordination of care across settings and strengthen beneficiary engagement; ensure rigorous benchmarking; promote interoperable electronic health record technology among ACO providers/suppliers; and improve information sharing on opioid use to combat opioid addiction.

For more information, refer to the Federal Register August 2018 Notice of Proposed Rule Making (NPRM).

2017

January 18, 2017

New ACOs Join the Shared Savings Program

CMS announced that 99 new ACOs and 79 renewing ACOs have been accepted to participate in the seventh cycle of the Shared Savings Program. As of January 1, 2017, there are 480 ACOs participating in the Shared Savings Program.

To view a complete list of participating ACOs, refer to PY 2017 Data.

For more information on Shared Savings Program data, visit the Program Data webpage.

2016

December 20, 2016

New Innovation Center Model Beginning PY 2018

CMS announced a new CMS Innovation Center model, the Medicare ACO Track 1+ Model (Track 1+ Model), beginning in 2018, that will test a payment design that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program to encourage progression to performance-based risk by Track 1 ACOs.

August 25, 2016

PY 2015 Financial and Quality Performance Results

CMS released financial and quality performance results for 392 ACOs with 2012, 2013, 2014, and 2015 agreement start dates.

To view the complete performance results, refer to PY 2015 Performance Results.

For more information on Shared Savings Program data, visit the Program Data webpage.

January 11, 2016

New ACOs Join the Shared Savings Program

CMS announced that 100 new ACOs and 147 renewing ACOs have been accepted to participate in the sixth cycle of the Shared Savings Program. As of January 1, 2016, there are 434 ACOs participating in the Shared Savings Program.

To view a complete list of participating ACOs, refer to PY 2016 Data.

For more information on Shared Savings Program data, visit the Program Data webpage.

2015

August 25, 2015

PY 2014 Financial and Quality Performance Results

CMS released financial and quality performance results for 333 ACOs with 2012, 2013, and 2014 agreement start dates.

To view the results, refer to PY 2014 Performance Results.

2014

December 22, 2014

New ACOs Join the Shared Savings Program

CMS announced that 89 new ACOs have been accepted to participate in the fifth cycle of the Shared Savings Program, which begins on January 1, 2015.

To view a complete list of participating ACOs, visit PY 2015 Data.

November 7, 2014

PY1 FINAL Financial and Quality Performance Results Released

CMS released the final financial and quality performance results for ACOs with 2012 and 2013 agreement start dates.

To view the results, refer to PY1 Performance Results.

September 22, 2014

PY1 Quality Performance Results

CMS announced the PY1 quality performance results for ACOs with 2012 and 2013 agreement start dates. For PY1, CMS defined the quality performance standard at the level of complete and accurate reporting for all quality measures. In PY1, 209 ACOs met the quality performance standard and were eligible to share in savings, if earned. Quality performance for PY1 reconciliation for ACOs with 2012 start dates is based on complete and accurate reporting of all required quality measures for Calendar Year 2012 (CY 2012) and CY 2013. Quality performance for PY1 reconciliation for ACOs with 2013 start dates is based on complete and accurate reporting of all required quality measures for CY 2013. The quality performance results provided in the PY1 announcement reflect CY 2013 performance rates for 220 ACOs. The CY 2013 mean quality performance rate for each measure, across all ACOs, is also provided.

September 16, 2014

PY1 FINAL Financial and Quality Performance Results Announced

CMS announced PY1 FINAL financial and quality performance results for ACOs with 2012 and 2013 agreement start dates. 53 ACOs with 2012 and 2013 start dates generated shared savings during their first performance year; PY1 is a 21- or 18-month period for ACOs with 2012 start dates, and a 12-month period for ACOs with 2013 start dates. ACOs that generated savings earned a performance payment if they met the quality standard. One Track 2 ACO with shared losses must repay CMS.

January 30, 2014

PY1 INTERIM Financial Reconciliation Results

CMS announced PY1 INTERIM financial reconciliation results for ACOs that started in April and July 2012. 31 ACOs that started in the Shared Savings Program in April or July 2012 generated shared savings or losses during their first 12 months of participation. We will complete the FINAL PY1 reconciliation later this year on all ACOs that started in 2012 and 2013. Consequently, an ACO's final performance results may differ from their interim results. ACOs that earned a performance payment were eligible for interim payment because they met the quality standard, elected the interim payment option in their application, and posted the required repayment mechanism. A Track 2 ACO with shared losses must repay CMS based on interim PY1 reconciliation if it elected the interim payment option in its application and posted the required repayment mechanism.

2013

December 23, 2013

New ACOs Join the Shared Savings Program

CMS announced that 123 new ACOs have been accepted to participate in the fourth cycle of the Shared Savings Program, which begins on January 1, 2014.

To view a complete list of participating ACOs, refer to PY 2014 Data.

January 10, 2013

New ACOs Join the Shared Savings Program

CMS announced that 106 new ACOs have been accepted to participate in the third cycle of the Shared Savings Program, which began on January 1, 2013.

To view a complete list of participating ACOs, refer to PY 2013 Data.

2012

July 9, 2012

New ACOs Join the Shared Savings Program

CMS announced that 88 new ACOs have been accepted to participate in the second cycle of the Shared Savings Program, which began on July 1, 2012.

April 10, 2012

New ACOs Join the Shared Savings Program

CMS announced that new ACOs have been accepted to participate in the first cycle of the Shared Savings Program, which began on April 1, 2012.

2011

November 10, 2011

The Shared Savings Program Final Rule

Page Last Modified:
12/29/2020 04:56 PM