The number of accountable care organizations participating in the Medicare Shared Savings Program dropped by about 7.7% in 2021.
The long-standing Medicare program now has 477 ACOs participating, a decline from 2020 when 517 participated, according to new CMS data. Additionally, 500,000 less Medicare beneficiaries are currently assigned to the program compared to 2020 when 11.2 million beneficiaries were treated by providers in an ACO.
Due to the pandemic, the Medicare Shared Savings Program didn't accept new applicants for 2021. Further, changes to the program under the Trump administration forces ACOs to take on downside risk sooner. CMS said the changes were made in part to encourage more savings for Medicare.
In response to the drop in participation of ACOs, the National Association of ACOs is calling on the Biden administration to make reforms to the program. NAACOs is asking for a July 2021 application period for new ACOs to apply, more time before ACOs must take on risk and certain changes to the program's methodology.
"Health Secretary nominee Xavier Becerra and the incoming Biden administration need to re-examine the balance of incentives and risk to ensure ACO growth and continued savings to Medicare, which ACOs have a history of producing," said Clif Gaus, CEO of NAACOs, in a statement.
In 2019, the 541 ACOs in the Medicare Shared Savings Program saved the agency $1.19 billion.
More ACOs are on the hook for losses in 2021, the CMS data shows. Forty-one percent of ACOs are in a two-sided risk track, compared to 2020 when 37% of ACOs were in such tracks, according to CMS. Sixteen percent of the ACOs participating in 2021 are in the Enhanced track, which holds the highest amount of downside risk. In 2020, 15% of ACOs were in that track.
Participation in the Medicare Shared Savings Program has fluctuated since CMS finalized changes in 2018 that forced downside risk sooner. Some ACOs responded by leaving the program or consolidating to form larger ACOs.