Accountable care organizations could get millions of dollars in additional payments if they take on greater risk, but health-care stakeholders caution such organizations often are not ready.
Consulting firm Avalere Health’s analysis showed ACOs in the Medicare Shared Savings Program (MSSP) would have gained $886 million in additional payments in 2015 if they took on two-sided risk, under which they take some responsibility for any losses. This includes a 5 percent bonus payment under the Quality Payment Program (QPP). However, over 92 percent of ACOs operate in a one-sided risk track where they bear no risk.
“This study really shows how much incentive there is to take on greater risk,” Allison Brennan, vice president of policy at the National Association of ACOs (NAACOS) in Washington, told me Aug. 3.
ACOs are groups of doctors, hospitals, and other health-care providers who work together to increase care coordination, improve patient outcomes, and reduce spending growth. They are part of a larger value-based approach to make Medicare payments based on results and outcomes instead of the number of services rendered.
In 2015, only 42 ACOs were in the two-sided risk Tracks Two and Three options, under which they may be responsible for repaying a portion of shared losses back to the Centers for Medicare & Medicaid Services. Organizations operating in the Track One option could have seen a $1.1 billion increase in payments from the 5 percent bonus payment and a $178 million payment from shared savings if they took on more risk, the study found. While 21 percent of Track One ACOs would have generated $437 million in net losses overall, one-third of them would have offset their losses by the bonus payment.
While the financial incentives for ACOs look good, Brennan told me the risk is still too high for many ACOs.
Read my full article here.
Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.
Learn more about Bloomberg Law and sign up for a free trial.
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)