ArticleHealth affairs (Project Hope)2019
Risk Adjustment In Medicare ACO Program Deters Coding Increases But May Lead ACOs To Drop High-Risk Beneficiaries.
Article in Health affairs (Project Hope), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Value-Based Provider Payment Initiatives Combining Global Payments With Explicit Quality Incentives: A Systematic Review.Medical care research and review : MCRR · 2020Pooled it
- Unattributed Medicare beneficiaries have greater social disadvantage than those linked to primary care physicians.Health affairs scholar · 2026Article
- Year 1 of Medicare's Accountable Care Organization Realizing Equity, Access, and Community Health Model.JAMA health forum · 2025Article
- Participation and attrition in the Medicare Shared Savings Program.Health affairs scholar · 2025Article
- Medicare Payments and ACOs for Dementia Patients Across Race and Social Vulnerability.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2024Article
- Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries.Risk management and healthcare policy · 2023Article
- Hospital-physician integration and risk-coding intensity.Health economics · 2022Article
- Small practice participation and performance in Medicare accountable care organizations.The American journal of managed care · 2022Article
- A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity.NAM perspectives · 2022Review
- Disparities in Preventable Hospitalization Among Patients With Alzheimer Diseases.American journal of preventive medicine · 2021Article
- Estimates of ACO savings in the presence of provider and beneficiary selection.Healthcare (Amsterdam, Netherlands) · 2021Article
- On Clinical Utility and Systematic Reporting in Case Studies of Healthcare Process Mining.International journal of environmental research and public health · 2020Article
- Savings or Selection? Initial Spending Reductions in the Medicare Shared Savings Program and Considerations for Reform.The Milbank quarterly · 2020Article
- Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations.JAMA network open · 2020Article
- Low-Value Care and Clinician Engagement in a Large Medicare Shared Savings Program ACO: a Survey of Frontline Clinicians.Journal of general internal medicine · 2020Article
- Gynecologic oncology care in the world of accountable care organizations.Gynecologic oncology reports · 2019Article
- Performance in the Medicare Shared Savings Program After Accounting for Nonrandom Exit: An Instrumental Variable Analysis.Annals of internal medicine · 2019Observational
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries' baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if beneficiaries' risk scores rise while in the MSSP. As a result, accountable care organizations (ACOs) have an incentive to avoid increasingly sick or expensive beneficiaries. We examined whether beneficiaries' exposure to the MSSP was associated with within-beneficiary changes in risk scores and whether risk scores were associated with entry to or exit from the MSSP. We found that the MSSP was not associated with consistent changes in within-beneficiary risk scores. Conversely, beneficiaries at the ninety-fifth percentile of risk score had a 21.6 percent chance of exiting the MSSP, compared to a 16.0 percent chance among beneficiaries at the fiftieth percentile. The decision not to upwardly adjust risk scores in the MSSP has successfully deterred coding increases but might discourage ACOs to care for high-risk beneficiaries in the MSSP .
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