(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 269
and share in savings with little or no actual improvement in the quality and efficiency of
care provided to beneficiaries.
The proposed confidence intervals were determined assuming that the variation in
the per capita expenditure growth for a particular ACO is equal to the variation in per
capita expenditure growth nationally. This is not the case for the majority of ACOs,
however, as regional growth rates tend to vary from the national average due to a number
of variables. Therefore, the confidence intervals generated using only the national
expenditure growth variation overstate the relative confidence associated with an
increasing group size. This is compensated for in two ways: (1) the 2 percent floor; and
(2) increasing the confidence interval as group size increases.
Table 6. Minimum Savings Rate and Confidence Intervals by Number of Assigned
Beneficiaries (One-Sided Model)
Number Beneficiaries
MSR (low end of
assigned beneficiaries)
MSR (high end of
assigned beneficiaries)
5,000 - 5,999 3.9% 3.6%
6,000 - 6,999 3.6% 3.4%
7,000 - 7,999 3.4% 3.2%
8,000 - 8,999 3.2% 3.1%
9,000 - 9,999 3.1% 3.0%
10,000 - 14,999 3.0% 2.7%
15,000 - 19,999 2.7% 2.5%
20,000 – 49,999 2.5% 2.2%
50,000 – 59,999 2.2% 2.0%
60,000 + 2.0%
We welcome comments on the most appropriate means to establish the MSR for an ACO,
including the appropriate confidence intervals.
11. Net Sharing Rate