MSSP ACOs Have Below Average Quality Results

Last week we reported the CMS announcement on ACO success—savings of $372 million and $445 million paid in bonuses. But a new report from Avalere Health notes that quality results are not keeping pace with cost reductions. It’s a prime example of ACO payment complexity.


Medicare Shared Savings Program (MSSP) ACOs were not required to meet quality measure benchmarks to share in savings during their first performance year. And, in fact, 59 percent of the participants that earned savings bonuses for 2013 had below average quality scores. The only ACO that had to repay CMS achieved better that average quality. (“Majority of ACOs with Shared Savings Scored Below Average on Quality Measures, Report Finds,” Health Lawyers Weekly, September 27, 2014)


But to put this in perspective, ACOs that earned bonuses generally outperformed the others on 15 measures, including screening patients for risk of falls and reconciling medication for patients who leave the hospital.


Those that failed to earn bonuses, however, did better on a few measures, including timely access to care and the percentage of doctors who met the federal criteria for the meaningful use of electronic health records. (“For their first year, ACOs see varied scores in quality measures,”Modern Healthcare A.M., September 29, 2014)


“These ACO results reveal a potential disconnect between achieving high-quality care as indicated by the ACO quality measures and the ability to achieve savings,” an Avalere Health executive, said. (Avalere Analysis, Most Medicare ACOs Earning Shared Savings Payments Were Below Average on Quality, Avalere Health, September 25, 2014)


Overall, the 220 ACOs that completed their first MSSP performance year in 2013 earned on average three-quarters of possible quality points, according to the report. However, “this average skews upward as fewer than two in five ACOs had better than average quality scores.” (Avalere Analysis, Most Medicare ACOs Earning Shared Savings Payments Were Below Average on Quality, Avalere Health, September 25, 2014)


Some specific results noted in the Avalere report include:


  • The top five quality measures by percent of ACOs earning maximum points:
    • Doctor Communication
    • Doctor Rating
    • All Condition Readmissions
    • Tobacco Use Assessment
    • Medication Reconciliation


  • The bottom five quality measures by percent of ACOs not earning points:
    • Avoidable Heart Failure Admissions
    • Avoidable COPD/Asthma Admissions
    • Diabetes Composite
    • Coronary Artery Disease Composite
    • Screening for Risk of Falls


After the first performance year, CMS will reduce shared savings payments to ACOs that don’t meet maximum quality benchmarks. ACOs that fall below minimum quality benchmarks will not share in savings at all.


For the full report from Avalere Health, please contact Carlin Lockee at





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