Medicare Shared Savings Program: The Complete Care Scheme

The Medicare shared savings program (MSSP) has been popular in the healthcare industry. It is the way to provide high-quality healthcare services at lower costs. This savings program is designed to reward the authorities for improving the quality of service. Various healthcare providers participate in MSSP to improve patient care at a lower cost.

According to the studies, the growth of this program has doubled since 2012. It has a dual advantage for patients and service providers. In this post, we will discuss the MSSP in detail and how it is a way of reducing expenses.

What Is the Medicare Shared Savings Program (MSSP)?

Medicare Shared Savings Program (MSSP) is a part of the primary Medicare program. It started during the George W. Bush administration in 2012. In the beginning, MSSP was permanently authorized by the Affordable Care Act. Creating the MSSP aims to provide high-quality healthcare at limited costs. It comes as an alternate financial model for the medical industry. 

This program rewards the healthcare industry for providing affordable services. Health providers, suppliers, and hospitals can participate in the Medicare Shared Savings Program. The crucial thing in this program is the teamwork of the professionals towards the same goal. To participate in the MSSP, healthcare providers must be a part of an Accountable Care Organization (ACO).

The Goal Behind Medicare Shared Savings Program

Let’s discuss the Medicare Shared Savings Program in detail. 

  • The part of the ACO works to improve patient care at little cost. This organization encourages healthcare suppliers and providers to share medical facilities. 
  • The ACO is accountable for sharing medical and financial responsibilities to limit unnecessary expenses. Medicare Shared Savings Program requires ACOs to bring the certified medicines to improve the quality.
  • The MSSP is a payment program under the Centers for Medicare & Medicaid Services(CMS). The estimated spending on this program will be around $1.5 trillion by 2027.
  • The U.S. government and CMS encourage it to reward providers for quality health services. It results in encouragement for others to join the Medicare Shared Savings Program.

What Is The Eligibility To Be A Part Of MSSP?

There is an eligibility criterion for healthcare specialists to join the Medicare Shared Savings Program. 

  • To form an ACO, all the participating providers must serve a minimum of 5,000 Medicare beneficiaries. Participation in the Medicare fee-for-service must be at least three years.
  • ACO professionals can be physicians, nurse practitioners, and clinical specialists. All the health care specialists must have a group practice arrangement.
  • Network of health specialists who have experience in serving beneficiaries. These can be the individual network of physicians.
  • Joint ventures between the ACO professionals and hospitals. Rural health clinics employ ACO professionals.
  • Federal Qualified teaching hospitals. These hospitals must elect to receive reasonable payment.

How Does The Medicare Savings Program 2022 Work?

All the ACO qualified healthcare organizations can participate in the Medicare Savings Program 2022. It encourages the various medical groups to form the ACOs. By creating the ACOs, these organizations are accountable for providing affordable Medicare services. 

The whole mechanism of the MSSP depends on primary care professionals. The process of providing affordable services starts with participation. That’s why the essential requirement is the experience of at least 5000 Medicare beneficiaries.

  • Medicare Savings Program 2022 assures ACOs promote evidence-based medicines. The participating ACOs must agree to the terms. One of the terms is promoting quality-based services.
  • MSSP promotes beneficiary engagement. It offers the rewards of maintaining quality healthcare services.
  • This program develops the methods that link quality and performance. The ACOs regularly report on cost and quality.
  • Coordinates directly with the ACOs to ensure quality. MSSP provides coordinated care within the ACO.
  • The Medicare Shared Savings Program measures quality daily. It uses 30 measures that focus on improving population health.

MSSP Financial Risk Criteria

To understand the role of various ACOs in the MSSP, you should know about the financial risk criteria. The financial risk starts with the responsibility of lowering the costs. If the ACOs cannot ensure lowering prices, they face a penalty. Let’s understand the MSSP financial risk criteria in detail:

Basic Financial Risk

MSSP’s essential financial risk starts with two years of upside-only trouble. The ACOs don’t face penalties for not meeting goals in this risk. They receive the incentive once they exceed the quality threshold. The primary financial risk encourages the ACOs’ participation. 

The savings in this risk are limited to 50% each year. This track takes the ACOs to increase risk levels. This is applicable for the first 3-4 years. After five years, the basic level ACOs move to an enhanced level.

Enhanced Financial Risk

At this risk level, the ACOs take on a higher risk. It is beyond the five years of the MSSP agreement period. At this level, the risk goes up to 60% annually. ACOs face a penalty for not meeting the goal. The story of financial risk is higher in enhanced financial risk.

What Should Beneficiaries Know About The Medicare Shared Savings Program?

All the beneficiaries can choose the provider of their choice.  Hospitals and physicians are encouraged to provide quality services. Medicare beneficiaries can benefit from affordable medical services. 

They can choose any MSSP-affiliated provider of their choice. It also offers the incentive of up to $20 for each qualifying care service. Medicare Shared Savings Programs allow ACOs to offer incentives to beneficiaries.

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Is MSSP Beneficial For You?

There are various pros and cons of the MSSP for healthcare authorities and people. The National Association of the ACOs finds out a few things.

  • It promotes stability in the form of more extended agreement periods. The new MSSP increases the risk over the previous one.
  • The basic track can give a lower risk to the ACOs. New healthcare providers’ upside to downside risk can be unpredictable.
  • It is still the question of how MSSP lowers healthcare costs. Various ACOs continue to work on the cause of creating healthy communities.

Conclusion

The Medicare Shared Savings Program creates a lot of benefits in a few years. It brings professional medical workers together with the same goal. Healthcare institutions work together to create affordable health solutions for millions of people. The various ACOs continuously work as part of this program. The above post will help you to understand the MSSP.

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Marsha Johnson
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