Accountable care organizations are more likely to stay in the Medicare Shared Savings Program if they achieve bonuses, even if it's just once, according to a new study.
The analysis, published Monday in Health Affairs, found that the risk of an ACO leaving the Medicare program is cut by more than three-quarters if they receive shared savings for at least one performance year. Overall, 30% of the 624 ACOs that participated at some point in the first five years of the program left. The findings come a few months after the CMS overhauled the program, which will force ACOs to take on risk sooner. Since then, concerns have been raised about whether or not ACOs will join or stick with the program.
Given the findings, the CMS should consider ways it can support opportunities the ACOs have to achieve savings, said William Bleser, lead author of the study and research associate of payment delivery system reform at the Duke-Margolis Center for Health Policy.
"When people can succeed in the program, they will stay in it," he said.
So far, most ACOs in the program have achieved savings but that can change as the ACOs are forced to take on downside risk sooner. In 2017, the most recent year data are available, about 60% of the 472 Medicare ACOs generated a total of $1.1 billion in savings for the CMS.
The CMS can create additional learning networks and offer more technical assistance, Bleser said.
The study also found that ACOs are most likely to exit the program in their third year. The rate of program exit for third-year ACOs was 20.7%. By comparison, the program exit rate for first-year ACOs was 4%, 9.5% for ACOs in their second year, 10.6% for fourth-year ACOs and 11.2% for ACOs in their fifth year.
Bleser said that's likely because by the third year ACOs have a better sense of how they are doing, as they have received second year performance data.
The changes to the MSSP program will require ACOs to take on downside risk after one to three years depending on their revenue. For most ACOs that means they will have to take on downside risk after two years in the program.
Bleser and his co-authors raise the concern in the study that this change "could cause successful ACOs to drop out of the program."
Research finds that physician-led ACOs are more likely to drop out of the program, Bleser said, but the fact that the CMS program accounts for an ACO's revenue, most physician-led ACOs likely won't have to take on downside risk until after three years in the program.
"It's something to monitor," he said.
The authors of this study have conflicts of interest . Bleser consults with pharmaceutical company Merck on vaccine litigation while David Muhlestein, another author of the study, is employed by Leavitt Partners, a consultancy that works with ACOs.