The Centers for Medicare and Medicaid saved a whopping $739 million last year, the second year in a row that it's turned a profit, from the Medicare Shared Savings Program.

As reported by Modern Healthcare, more accountable care organizations took on downside risk last year, which brought in greater savings than in 2017—when CMS saved $314 million.

Approximately 66 percent of the 548 Medicare accountable organizations produced a total of $1.7 billion in savings in 2018; the $739 million CMS saved amounts to about $73 in savings per beneficiary, which doesn't add up to much when considered in light of overall Medicare spending.

There are two tracks in the program—Track 1 and Track 1+—and the latter is the one that involves downside risk; it was available for the first time last year. Ninety-five ACOs signed up for downside risk tracks, with 55 percent of those in Track 1+. The number of ACOs in Track 1, which does not involve downside risk, totaled 453, accounting for 82.6 percent of ACOs. In 2017, 92 percent were in Track 1.

According to David Muhlestein, chief research officer at Leavitt Partners, ACOs are opting for the downside risk track were confident that they would do well there. Modern Healthcare notes that downside risk tracks are considered "advanced alternative payment models under MACRA… Clinicians are exempt from MIPS if they are in an advanced alternative payment model and qualify for a 5 percent payment bonus."

"It gave them (the ACOs) that sweet spot where they can assume downside risk but in a reasonable manner," said Allison Brennan, senior vice president of government affairs at the National Association of ACOs.

The downside risk ACOs were also more likely to succeed in savings, with 59 of the 95 downside risk ACOs receiving a bonus; only 146 of the 453 upside-only ACOs managed to do the same.

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Medicare ACO program saved CMS $739 million in 2018

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