This past holiday season, the Centers for Medicare & Medicaid Services (CMS) decided it was time to turn up the heat on Accountable Care Organizations (ACOs). On December 21st, CMS issued a final rule named “Pathways to Success” that drastically restructures the Medicare Shared Savings Program (MSSP) and expedites the time that ACOs have before they need to take on more risk.
CMS launched MSSP in 2012 to encourage healthcare providers to get more skin in the game by offering performance-based payment models in which ACOs could be eligible to share in savings that resulted from decreasing costs and increasing quality of care. The percentage of cost savings that ACOs could keep was dependent on whether the ACO was also willing to be accountable for downside risk, meaning they could need to cut a check if their Medicare beneficiary costs went up instead of down.