{"id":20272,"date":"2018-06-22T10:30:30","date_gmt":"2018-06-22T14:30:30","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=20272"},"modified":"2025-10-27T11:17:14","modified_gmt":"2025-10-27T11:17:14","slug":"medicare-shared-savings-program-mssp","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/medicare-shared-savings-program-mssp\/","title":{"rendered":"What is the Medicare Shared Savings Program (MSSP)?"},"content":{"rendered":"

Medicare Shared Savings Program (MSSP)<\/span><\/h2>\n

Provide high-quality, coordinated care to improve outcomes and reduce costs. That\u2019s the primary goal of the <\/span>Medicare Shared Savings Program (MSSP)<\/span>. The MSSP is an alternative payment model in which eligible providers, hospitals, and suppliers are rewarded for achieving better health for individuals, improving population health, and lowering growth in healthcare expenditures. <\/span><\/p>\n

Coming together to effect change<\/span><\/h2>\n

In the MSSP, teamwork is paramount. To participate, providers must be part of an <\/span>Accountable Care Organization (ACO)<\/span><\/a>, a patient-centered network that shares financial and medical responsibilities with the goal of improving patient care while limiting unnecessary spending. The MSSP requires ACOs to promote evidence-based medicine, engage beneficiaries, report internally on quality and cost metrics, and provide coordinated care across and among primary care physicians, specialists, and acute and post-acute providers. In the ACO, everyone works together to streamline processes, reduce duplication, and improve quality\u2014and everyone shares in the financial savings as well as potential risks that ensue. <\/span><\/p>\n

The MSSP has grown steadily since it began in 2012 when only 220 ACOs existed. Currently, 561 MSSP ACOs provide care to 10.5 million beneficiaries nationwide, <\/span>according to the Centers for Medicare & Medicaid Services (CMS)<\/span>. This growth is due, in part, to an increased awareness of the revenue-generating opportunities inherent in ACOs as well as a desire to avoid financial penalties under the <\/span>Merit-based Incentive Payment System (MIPS)<\/span><\/a>. Physicians who participate in an advanced Alternative Payment Model such as a <\/span>Next Generation ACO<\/span><\/a> and meet certain parameters are exempt from MIPS reporting. A Next Generation ACO is similar to a traditional ACO; however, participants assume a higher level of financial risk. To be eligible for incentive payments under MIPS, physicians must receive 25% of their Medicare Part B payments or see 20% of their patients through the advanced APM. <\/span><\/p>\n

Financial risk and the MSSP<\/span><\/h2>\n

To understand truly understand the role of ACOs in the MSSP, one must understand the concept of financial risk. It\u2019s the idea that ACOs in the MSSP can\u2014and should\u2014take on some degree of responsibility for lowering costs (i.e., ensuring that actual expenditures don\u2019t exceed updated historical benchmark data). When they don\u2019t accomplish this goal, they may be penalized. However, when they do, they\u2019re rewarded. <\/span><\/p>\n

The MSSP provides participants with the following four ACO options, each of which requires an ACO to <\/span>assume a different level of risk<\/span>:<\/span><\/p>\n