(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 350
section.
Table 10: Estimated Net Federal Savings, Costs and Benefits, Years 1-3
Federal Savings Year 1 Year 2 Year 3 Total (Years 1-3)
90 th Percentile $30 Million $90 Million $50 Million $170 Million
Median $100 Million $210 Million $200 Million $510 Million
10 th Percentile $190 Million $380 Million $390 Million $960 Million
Costs
Total ACO start-up investment and first year operating expenditures average
from $131,643,825 to $263,287,650, for the estimated range of 75-150
participating ACOs.
Benefits Improved healthcare delivery and quality of care and better communication
to beneficiaries through patient centered-care.
As discussed in the preamble of this proposed rule, the Shared Savings Program
establishes a program whereby groups of suppliers and providers can work together through
ACOs that would assume responsibility for managing and coordinating the care of groups of
traditional FFS Medicare patients. Participating ACOs will have the opportunity to earn shared
savings payments by reducing Medicare expenditure growth for their assigned beneficiaries
below specified target thresholds or benchmarks while simultaneously meeting quality
performance measures. An ACO could initially opt for one of two program tracks. The first
option (one-sided model) offers eligibility for shared savings payments in years 1 and 2 without
the risk of being responsible for repaying any losses if actual expenditures exceed the
benchmark, followed by a third year offering a higher percentage of shared savings but also risk
for excess expenditures above the benchmark. The second option (two-sided model) provides an
opportunity for receiving a higher percentage of shared savings for all 3 years, but with potential
liability in each of the 3 years for annual expenditures that exceed the benchmark.
There is substantial uncertainty as to the number of ACOs that will participate in the
program, their characteristics, provider and supplier response to the financial incentives offered
by the program, and the ultimate effectiveness of the changes in care delivery that may result as