Coordinated Medicare Networks Nervous About Financial Risk

Doctors and hospitals that coordinate care for certain Medicare patients aren’t likely to see a reprieve from taking on financial risks next year, industry sources told Bloomberg Law.

Industry groups say that forcing some health-care providers to repay Medicare for certain losses starting in 2019 in the accountable care organization program will likely shrink the program’s participation and hurt the move from fee-for-service care to a value-based care system. Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health-care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. If they save Medicare money, these groups can reap financial rewards.

Right now, 82 percent of the Medicare ACOs are Track 1, meaning they share in savings generated but they don’t have to pay back money if they fail to meet program goals, according to the Medicare agency. That will change in 2019 as some of these ACOs will move out of Track 1, unless the Centers for Medicare & Medicaid Services agrees to revise program rules and let them stay in Track 1, which is what doctors and other health groups want. Overall, about 10.5 million Medicare beneficiaries are served by 561 ACOs, which is a jump from 9 million beneficiaries and 480 ACOs in 2017.

Allison Brennan, vice president of policy at the National Association of Accountable Care Organizations (NAACOs), told me that while she supports transitioning ACOs to risked-based models, some organizations are not prepared yet, and could end up quitting the program if forced into them too early.

Read my full article here.

Stay on top of new developments in health law and regulation, and learn more, by signing up for a free trial to Bloomberg Law.