Main Library
Medicare’s unprecedented and unpredictable spending growth in recent years is penalizing clinicians who have been most effective at slowing cost growth and improving care. The Accountable Care Prospective Trend (ACPT) in the Medicare Shared Savings Program (MSSP) could cost accountable care clinicians more than $700 million in lost shared savings for care delivered in 2025. These reductions are the result of inaccurate forecasting embedded directly into MSSP benchmarks.
How ACPT Went from Solution to Systemic Risk
The Centers for Medicare and Medicaid Services (CMS) created the ACPT to address a legitimate concern: benchmark ratcheting that occurs when ACOs successfully slow spending growth. The agency designed ACPT to “allow for benchmarks to increase beyond actual spending growth rates as ACOs slow spending growth,” helping preserve incentives for continued participation and investment in accountable care. CMS acknowledged early on that this approach carries challenges, noting that “there are circumstances that may warrant reducing the weight placed on the ACPT on an ad hoc basis.”
Unfortunately, what seemed as a possibility is now the standard as the ACPT has introduced a new cycle of uncertainty and financial exposure, one where ACOs must wait each year to see whether CMS’ spending projections align with reality or whether retrospective adjustments will be needed to correct the damage.