Proposed Revisions to Medicare Shared Savings Program: CMS Encourages Participation


The Centers for Medicare and Medicaid Services (CMS), as part of 2023 Physician Fee Schedule proposed rule, has proposed significant revisions to the Medicare Shared Savings Program (MSSP). The revisions to the MSSP in the proposed rule (the Rule) are designed to address the lack of growth in beneficiary participation in the MSSP and the fact that higher spending beneficiary populations, and racial and minority beneficiaries are increasingly underrepresented in the MSSP.

Summary

The MSSP has been the leading and most popular government alternative payment program since its introduction with the passage of the Affordable Care Act (ACA). Many hoped that the health care delivery system would transform relatively quickly following passage of the ACA to one paying for value and not more procedures. In 2018, CMS significantly revised the MSSP through its Pathways to Success, with the revisions designed to accelerate the transition to downside risk for participating providers, which we discussed in an earlier blog post. The Pathways to Success revisions established a glide path requiring accountable care organizations (ACOs) to move to downside risk after two years in the MSSP and with the level of risk and reward increasing over the five-year term of participation.

Since 2018, the number of beneficiaries participating in the MSSP has slowed significantly from the growth trend prior to 2018. From 2012/2013 to 2018, there had been a steady increase in participation from 3.2 million beneficiaries participating to 10.4 million. Since 2018, the number of beneficiaries participating in the MSSP has bounced up and down a little, but effectively plateaued, with an estimated 11 million participating in 2022.

In the Rule, CMS proposed changes that it hopes will grow membership and make the MSSP more appealing to providers, even if it slows the moving of all participants to downside risk. Among the more significate changes are:

Principal Revisions

The principal revisions in the Rule include:

Conclusion

In the Rule, CMS addresses a number of issues that it believes will encourage more providers, particularly inexperienced and smaller revenue providers, to join ACOs and participate in the MSSP. The availability of participation without downside risk over a full agreement period and allowing for advance investment payments to pay for infrastructure, which payments are only recouped from shared savings if the ACO does not participate throughout the entire agreement period, appear to be changes that may lead to increased participation.

The fact that growth in the most popular government value-based program needs to be encouraged also signifies that the conversion to a value-based health care delivery system is a slow process that is unlikely to occur in the near future. 


© 2025 Foley & Lardner LLP
National Law Review, Volume XII, Number 235