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CMS, NAACOS Have Entirely Different Takes on the MSSP ACO Program


The CMS saw good news in its annual report on the federal healthcare agency’s largest ACO program. The National Association of ACOs say the report shows the program is shrinking and needs changes.

CMS heralded the facts and figures in its annual summary of the Medicare’s main ACO program as good news today.

The press release says 66 new ACOs joined the program and 140 renewed their participation, bringing the total number of ACOs in the healthcare agency’s main ACO program, the Medicare Shared Savings Program (MSSP) to 483. And, accordign to the press release, 11 million beneficiaries were receiving care from a provider in a MSSP ACO, an increase of 324,000 beneficiaries , or 3%, from 2021, according to the press release.

“With one in every five health care dollars paid by Medicare, we can strengthen and transform our health care system,” Chiquita Brooks-LaSure, the CMS administrator, was quoted as saying. “Accountable care organizations present an invaluable opportunity to move Medicare toward person-centered care.”

But the main industry group for ACOs saw bleaker news in some of the same numbers.

Clif Gaus, Sc.D., the president of the group, the National Association of ACOs (NAACOs), said in the group’s press release that the news in CMS’ annual summary was “extremely disappointing” and that participation in Medicare ACOs could be seen as shrinking, not growing, because some of new sign-ups in the MSSP came from the another Medicare ACO program, called Next Generation, that ended last year.

NAACOS’ press release described the increase in the number of MSSP ACOs from 2021 from 477 to 483 as modest and noted that the number of beneficiaries is lower the high-water mark of 11.2 million. NAACOS also tallied the number of ACOs starting their first initial contract period with the MSSP at 46, not 66.

Source: CMS Shared Savings Program Fast Facts, as of January 2022

Source: CMS Shared Savings Program Fast Facts, as of January 2022

The organization traces what it sees as a troubled MSSP program to the Trump’s administration 2018 rulemaking, branded as the “Pathways to Success,” which tightened up the rules for how long ACOs could participate in the program before taking on “downside” risk — in effect paying a penalty if they fell short of meeting financial benchmarks instead of just “upside risk” that pays bonuses to ACOs if their expenditures are below financial benchmarks. They must also have to do well on quality metrics to be eligible for those “shared savings” bonuses.

The MSSP hasn’t rebounded from where ACO participation was before CMS’s 2018 rulemaking, dubbed ‘Pathways to Success,’ that forced more ACOs into risk,” says NAACOS press release.

Related: How to Avoid an ACO Exodus — or Having No Takers in the First Place

The ACO organization has suggested making changes to the MSSP program that it says will attract more ACOs into the MSSP program, including adjustment to the shared savings calculation that would increase the rewards for beating financial benchmark, modifying risk adjustment that are supposed to take into account how sick the beneficiaries are, and lengthening the time that ACOs can stay in upside risk only.

Meanwhile, the CMS press release heaped praise on ACOS for being “an important innovation for moving CMS' payment systems away from paying for volume and towards paying for value and outcomes.” The press release also noted that the proportion of ACOs that qualify as Advanced Alternative Payment Models (APMs) has increased from 34% to 50%. Providers participating in APMs are eligible for larger value-based payments because the programs are believed to do more to incentivize cost-effective care.

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