MSSP ACOs May Not Improve Spending, Quality of Care

After adjustment for the nonrandom exit of clinicians, the Medicare Shared Savings Program (MSSP) is not associated with improvements in spending or quality, according to a study published online June 18 in the Annals of Internal Medicine.

Adam A. Markovitz, from the University of Michigan Medical School and School of Public Health in Ann Arbor, and colleagues examined the effect of the MSSP on spending and quality while accounting for clinicians' nonrandom exit. MSSP accountable care organization (ACO) participants were compared to control beneficiaries using adjusted longitudinal models. Data were included for a 20 percent sample (97,204,192 beneficiary-quarters).

The researchers found that the MSSP correlated with spending reductions in adjusted longitudinal models (change, −$118 [95 percent confidence interval, −$151 to −$85] per beneficiary-quarter) and improvements in all four quality indicators assessed. The MSSP was not associated with spending (change $5 [95 percent confidence interval, −$51 to $62] per beneficiary-quarter) or in quality in instrumental variable models. High-cost clinicians exiting ACOs was a driver of the compositional changes: The chance of exiting the MSSP was 30.4 percent for high-cost clinicians (99th percentile) versus 13.8 percent for median-cost clinicians (50th percentile).

"These findings suggest caution in extending ACOs to other settings and patients without stronger evidence that the program saves money or improves quality of care," the authors write.

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