- The Medicare Shared Savings Program will expand substantially in January 2015, when the program will add another 89 organizations to its ACO roster.
- The additions will bring the number of ACOs in the program to 405, and increase the number of Medicare enrollees getting care from ACO physicians from 4.9 million to 7.2 million.
- Despite this growth, critics note that none of the new ACOs starting next year have opted for the more aggressive option available the program, which increases bonus sizes if participants assume the risk of penalties in the first three years. This underscores the fact that many participants feel that the program rules have limited their ability to manage the cost and quality of care, they say.
There's no question that having 89 ACOs join the MSSP is a good sign. It suggests that new rules proposed by CMS earlier this month that would allow ACOs to avoid the risk of penalties for up to six years are attractive to provider organizations. While providers are not entirely satisfied with the program as it exists, attracting a substantial new class of participants bodes well for the program's future. And the MSSP has generated financial benefits for at least some of the participants, with about 25% of the 220 ACOs enrolled sharing $300 million dollars to date.
That being said, it remains to be seen how successful the new proposed rules are—including a provision creating a new vehicle to help ACOs with capital investments—as we don't yet know whether the 200+ organizations already involved will renew their initial contracts. Contracts for those ACOs expire at the end of 2015.
The extent to which Medicare can retain these original players should say a lot about the success of the MSSP. After all, while Medicare can recruit new players to replace any of the original team that drops out, it's likely to lose momentum if too many of the initial players decline to renew their contracts. The next 12 months should be an important time in the history of the program.