Adam A. Markovitz is an MD-PhD candidate in the Department of Health Management and Policy, University of Michigan School of Public Health, and the University of Michigan Medical School, in Ann Arbor.
John M. Hollingsworth is an associate professor in the Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, in Ann Arbor.
Health Aff (Millwood). 2019 Feb;38(2):253-261. doi: 10.1377/hlthaff.2018.05407.
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 .
医疗保险共享储蓄计划（MSSP）根据受益人的基线风险评分调整储蓄基准。为了抑制编码强度的增加，如果受益人的风险评分在 MSSP 期间上升，基准不会向上调整。因此，负责医疗保健的组织（ACO）有动力避免越来越多的患病或昂贵的受益人。我们研究了受益人的 MSSP 暴露是否与受益人的风险评分的个体内变化相关，以及风险评分是否与进入或退出 MSSP 相关。我们发现 MSSP 与个体内风险评分的一致变化无关。相反，风险评分处于第 95 个百分位数的受益人的 MSSP 退出率为 21.6%，而风险评分处于第 50 个百分位数的受益人的 MSSP 退出率为 16.0%。MSSP 中不向上调整风险评分的决定成功地阻止了编码的增加，但可能会阻碍 ACO 在 MSSP 中为高风险受益人提供护理。
