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In less than a decade, accountable care organizations (ACOs) have grown from nothing to caring for nearly 20% of all Medicare beneficiaries. Throughout this period of remarkable growth, quality improvement has been a critical component of Medicare ACO programs. A set of predefined quality measures incentivizes doctors, hospitals, and other providers in an ACO to provide optimal care coordination, preventive services, and chronic disease management. Shared savings rates—and whether an ACO receives any shared savings at all—are determined by quality performance.
Those incentives are working. The HHS Office of Inspector General found that ACOs outperformed fee-for-service providers on 81% of quality measures and improved quality over time in the program. ACOs also hit an average quality score of more than 94% in 2019, the latest year for which Medicare data are available.
But despite ACOs’ positive track record on quality improvement, CMS is dramatically overhauling quality measurement within the Medicare Shared Savings Program (MSSP), CMS’ largest and most successful alternative payment model. In the waning weeks of the Trump administration, CMS finalized several changes, including the mechanism for which ACOs submit data to CMS, what is being measured, on whom quality is measured, ways in which shared savings are determined, the number of patients on which data are submitted—and the list goes on.