About Medicare Shared Savings Program (MSSP) for Providers

Medicare Shared Savings Program

Make the most of your participation

Contact us

Do you have a questions about MSSP participation, policies, requirements or resources? Contact the ACO operations team.

Making our collective participation successful

For years, providers across Scripps have worked together to improve value by reducing costs, improving quality and service, and expanding access to people who want to come to Scripps for their care. These ongoing efforts helped the Scripps ACO receive CMS approval to participate in the Medicare Shared Savings Program (MSSP) — and will help ensure our collective participation is successful.

What is the Medicare Shared Savings Program?

The Affordable Care Act of 2010 established several initiatives to reform Medicare delivery, including the MSSP. Its purpose is to facilitate coordination among providers to improve quality of care and reduce unnecessary costs for Medicare fee-for-service patients.

Physicians and hospitals may participate in the MSSP by forming or joining an Accountable Care Organization. The MSSP rewards ACOs that meet its cost and quality goals. Specifically, an ACO that meets 34 publicly reported quality measures and keeps its population’s cost of care below the defined threshold shares in the savings achieved. Learn how Scripps ACO collects and reports required quality measures.

What's unique about Scripps ACO’s participation in the MSSP

Three key features distinguish Scripps ACO from other ACOs that participate in the MSSP:

We are a Track 3 Program

Scripps ACO is an MSSP Track 3 ACO. This means there are higher shared savings opportunities because the ACO takes greater downside risk. Track 3 ACOs have a maximum shared savings rate of 75 percent based on quality performance.

As a Track 3 participating provider, your beneficiaries are assigned prospectively (based on historical claims data). New beneficiaries cannot be added during a performance year, but beneficiaries can be dropped from your assignment.

Under the MSSP ACO, you continue to bill Medicare fee-for-service as usual, then any realized shared savings payments are distributed after each performance year. Your normal fee-for-service reimbursements from CMS are not impacted.

Remember that Medicare fee-for-service beneficiaries are not restricted to ACO-only providers; they can seek care wherever they wish. The impetus is on your practice to provide an outstanding experience that drives patient satisfaction and loyalty.

We are an Advanced Alternative Payment Model (AAPMs)

Scripps ACO is also an Advanced Alternative Payment Model (AAPM). Advanced APMs let providers earn more rewards in exchange for taking on more risk related to patient outcomes.

For performance years 2017 - 2022, a 5 percent APM incentive payment
For performance year 2023, a 3.5 percent APM incentive payment
For performance years 2024 and beyond, an increased physician fee schedule update based on the QP conversion factor

Providers who meet AAPM performance criteria earn a 5 percent lump sum bonus on Medicare Part B professional billings. They also are exempt from MIPS reporting, and avoid the +/-4 percent MIPS adjustment.

Learn more about Advanced APMs, and how you can achieve Qualifying Provider status.

We use the SNF 3-Day Rule and Waiver

Track 3 ACO providers may use the Skilled Nursing Facility (SNF) 3-Day Rule Waiver under the following circumstances:

Your Medicare fee-for-service patient meets certain clinical criteria

-AND-

You refer him or her to a SNF within Scripps Preferred Network

Learn more about the SNF 3-Day Rule Waiver.

Public reporting for participating ACOs

Visit Scripps.org/ACO to view our public reporting data, including ACO participants, quality performance results, governing body, leadership, committee members and primary contact.