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The Milbank quarterly · Sep 2020
Savings or Selection? Initial Spending Reductions in the Medicare Shared Savings Program and Considerations for Reform.
- J Michael McWILLIAMS, Laura A Hatfield, Bruce E Landon, and Michael E Chernew.
- Harvard Medical School.
- Milbank Q. 2020 Sep 1; 98 (3): 847-907.
AbstractPolicy Points Concerns have been raised about risk selection in the Medicare Shared Savings Program (MSSP). Specifically, turnover in accountable care organization (ACO) physicians and patient panels has led to concerns that ACOs may be earning shared-savings bonuses by selecting lower-risk patients or providers with lower-risk panels. We find no evidence that changes in ACO patient populations explain savings estimates from previous evaluations through 2015. We also find no evidence that ACOs systematically manipulated provider composition or billing to earn bonuses. The modest savings and lack of risk selection in the original MSSP design suggest opportunities to build on early progress. Recent program changes provide ACOs with more opportunity to select providers with lower-risk patients. Understanding the effect of these changes will be important for guiding future payment policy.© 2020 Milbank Memorial Fund.
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