Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
Oct. 6 — Accountable care organizations haven’t created substantial savings for the government and some should be pushed to take on more risk, Congress’s Medicare advisers said Oct. 6.
ACOs are groups of doctors, hospitals and other providers working together to provide better, more coordinated care with the aim of lowering Medicare’s costs. However, ACOs in the Medicare Shared Savings Program cost the Centers for Medicare & Medicaid Services $216 million in 2015, staff with the Medicare Payment Advisory Commission (MedPAC) said in a presentation.
Data on ACOs reported by MedPAC offer a more detailed look at the ACOs compared with the program information the CMS has released. For example, in 2015, MSSP ACOs generated total program savings (inclusive of all savings and losses relative to financial benchmarks) of $429 million, the CMS said in August (166 HCDR, 8/26/16). However, MedPAC's data showed the $216 million loss the CMS took for the MSSP resulted from the agency paying providers $646 million for the savings they generated.
MedPAC's financial results for the ACO program are “incredibly unsatisfying,” Commissioner Craig Samitt, an executive vice president and chief clinical officer at Anthem Inc. in Indianapolis, said. Noting that some ACOs have generated savings for the Medicare program, Samitt urged MedPAC to research what’s driving savings at the most successful organizations.
Commissioner Willis Gradison, a former Republican House lawmaker and health insurance lobbyist, blamed the financial results on the fact that many ACOs are participating in one-sided (or savings only) risk models. The commission should develop recommendations that encourage more ACOs to take on two-sided risk (savings and losses), Gradison, who lives in McLean, Va., said.
In addition, it was wrong to create so many different ACO models, Gradison told the commission. The CMS shouldn't have allowed so many providers to participate while the models remained as demonstration, or test, projects, he said.
The MSSP model, along with another the Pioneer ACO demo, served 7.7 million beneficiaries in 2015. The MSSP model is much bigger, as the Pioneer program—which is designed for organizations with more experience in coordinating care—only serves 461,442 beneficiaries, according to an August fact sheet from the CMS.
Commissioners didn't vote on any recommendations during the ACO session.
MedPAC Chairman Francis J. Crosson said he's also disappointed with the progression of the ACO program to date. Some program modifications may be necessary, he said without specifying what changes the ACO may need to generate greater savings.
Crosson, of Palo Alto, Calif., is a former Kaiser Permanente executive.
To contact the reporter on this story: Michael D. Williamson in Washington at firstname.lastname@example.org
To contact the editor responsible for this story: Brian Broderick at email@example.com
Copyright © 2016 The Bureau of National Affairs, Inc. All Rights Reserved.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)