Unpacking The Medicare Shared Savings Proposed Rule: Geography And Policy

Conclusions Depending on one’s perspective, the early results of the MSSP are either promising or disappointing. On the one hand, nearly a quarter of qualifying ACOs achieved shared savings in the first year of performance; on the other, three-quarters either did not lower spending or did so but failed to exceed the minimum savings rate. Our analysis suggests that, using Hospital Referral Region spending as a proxy, the way medicine is practiced (or at least has been practiced) in a region is important to the ACO’s ability to generate shared savings under current benchmarking methdology. We conclude that some adjustments to the Medicare Shared Savings Program are warranted, but that those adjustments should not disrupt positive movements in other areas of the country. Improvements in the benchmarking formula, the risk adjustment methodology, and perhaps additional incentives to sustain high performance over a longer period are worth exploring. Methodological Appendix: The Influence Of Geography On Likelihood Of Shared Savings For MSSP ACOs We addressed the question by using the most current list of participating MSSP ACOs available on the CMS website, which includes United States Postal Service zip codes associated with each ACO’s operating address. Using the ACO’s zip code, we linked the September 2014 list of the MSSP ACOs to its corresponding Dartmouth Hospital Referral Region (HRR). The HRR is a commonly used geographic measure of where patients from a particular ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: All Categories Health Care Costs Health Reform Hospitals Insurance Medicare Payment Policy Quality Spending Source Type: blogs