Find the latest press releases about the Shared Savings Program and related initiatives.
Shared Savings Program Final Rule
On December 31, 2018, the Centers for Medicare & Medicaid Services (CMS) published a final rule that sets a new direction for the Medicare Shared Savings Program (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 Accountable Care Organizations (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 (BBA of 2018), specifically in the areas of new beneficiary incentives, telehealth services, and choice of beneficiary assignment methodology.
The Physician Fee Schedule (PFS) final rule published in November 2018 addresses a subset of changes to the Medicare 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.
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 Accountable Care Organizations (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.
CMS announced that 99 new Accountable Care Organizations (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.
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.
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.
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.
Sept 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.
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.
Dec 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.