Buzzword of the Week: Medicare Shared Savings Program

My husband arrived home form work the other evening, his last meeting of the day had been with a hospital exec to discuss the workings of healthcare reform.  “Have you heard of MSSP?” he asked me, obviously overestimating my knowledge of healthcare buzzwords.

I hadn’t heard of MSSP (Medicare Shared Savings Program), a provision included in one of the estimated 13,000 to 32,000 pages of new healthcare law under the Affordable Care Act (printed out, the bill amounts to a stack of papers as tall as Kobe Bryant according to one blogger).  Although MSSP conditions are just one small provision of new healthcare law, this program has big implications for providers and the structure under which patients receive medical care.

While the MSSP is a bit complex, it’s important that we as nurse practitioners and physician assistants delve into understanding the bits and pieces of the Affordable Care Act that impact our careers.

What is the Medicare Shared Savings Program?

To understand the Medicare Shared Savings Program, first you must be familiar with Accountable Care Organizations (ACO’s).  An ACO is similar to an HMO (Health Maintenance Organization) with which many providers are familiar.  An ACO is a group of medical providers and hospitals coming together with the goal of increasing quality of patient care while decreasing costs for an assigned group of patients.

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According to CMS (The Center for Medicare Services), the official definition of ACO is “an organization of healthcare providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it”.  The Center for Medicare Services hopes that ACO’s will reduce fragmentation of the healthcare system and improve population health all while lowering expenditures.

The Medicare Shared Savings Program is simply the program under which Accountable Care Organizations are created and regulated.  The MSSP outlines the guidelines under which ACOs are established.

Why would your hospital or provider group want to participate in the MSSP?

The Medicare Shared Savings Program hopes to accomplish its goal of improving quality of care at a decreased cost by financially incentivizing healthcare providers.  Accountable Care Organizations formed under the MSSP are eligible to receive a share of any savings they incur.  For example, if providers that are part of an ACO order fewer medical tests on their Medicare patients, they lower the cost of care for this patient population.  In turn, Medicare will reimburse the ACO a percentage of this savings.  Hospitals, individual providers and other healthcare organizations stand to make a profit by participating in the MSSP.

Accountable Care Organizations that do not reach savings goals under the MSSP will no be penalized for their performance.  The only financial disincentive for participation in the MSSP would be increased administrative costs (someone has to do the paperwork necessary for participation as well as track performance) but most healthcare organizations believe incentive payments outweigh these operational setbacks.

How will the MSSP affect you as an NP or PA?

If you work for a provider group or hospital that is part of an Accountable Care Organization under the MSSP, you may notice some changes in your company to accommodate MSSP regulations.  For example, the MSSP requires certain quality of care measures to be tracked.  This means changes like modification of your electronic charting system prompting you to document certain events, tests or exam findings.  Your employer may encourage reduced medical testing for Medicare patients in order to keep their cost of care to a minimum.

ACOs will push to improve quality of care, work in a more integrated manner and reduce usage of unnecessary tests.  As an NP or PA working for an ACO, you can expect administrative changes to facilitate these goals.

It is yet to be seen how effective the Medicare Shared Savings Program will be in improving quality and cost of care for Medicare beneficiaries.  But, with financial incentives in place, many provider groups and hospital systems will try to capitalize on this program.


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