Accountable care organizations (ACOs) created under the Affordable Care Act (ACA) are meeting their goals of improving patient care while saving Medicare money, the Centers for Medicare and Medicaid Services (CMS) said Sept. 16. ACOs in the Pioneer ACO Model and Medicare Shared Savings Program (MSSP) generated more than $372 million in total program savings for Medicare ACOs, the agency said in a fact sheet. ACOs also qualified for shared savings payments of $445 million. The results come from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs (which have more experience with coordinating care) and final results from the first year of performance for 220 Shared Savings Program ACOs, CMS said. More than 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare, according to CMS. Medicare ACOs are groups of providers and suppliers of services that work together to coordinate care for Medicare fee-for-service beneficiaries. In its first report on the operation of Medicare’s ACO program, CMS in January said the entities shared in $273 million of savings in 2012 and funneled an additional $128 million to the Medicare trust fund. The Pioneer program is administered […]
Accountable care organizations (ACOs) created under the Affordable Care Act (ACA) are meeting their goals of improving patient care while saving Medicare money, the Centers for Medicare and Medicaid Services (CMS) said Sept. 16.
ACOs in the Pioneer ACO Model and Medicare Shared Savings Program (MSSP) generated more than $372 million in total program savings for Medicare ACOs, the agency said in a fact sheet. ACOs also qualified for shared savings payments of $445 million.
The results come from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs (which have more experience with coordinating care) and final results from the first year of performance for 220 Shared Savings Program ACOs, CMS said.
More than 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare, according to CMS. Medicare ACOs are groups of providers and suppliers of services that work together to coordinate care for Medicare fee-for-service beneficiaries.
In its first report on the operation of Medicare’s ACO program, CMS in January said the entities shared in $273 million of savings in 2012 and funneled an additional $128 million to the Medicare trust fund.
The Pioneer program is administered under CMS’s Center for Medicare and Medicaid Innovation and is designed for health-care organizations and providers that have experience coordinating care for patients across care settings. The program allows those provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the MSSP.
Spending Money Wisely
“We all have a stake in improving the quality of care we receive, while spending our dollars more wisely,” Health and Human Services (HHS) Secretary Sylvia Mathews Burwell said in a press release. “It’s good for businesses, for our middle class, and for our country’s global competitiveness. That’s why at HHS we are committed to partnering across sectors to make progress.”
Some providers have been critical of the program. In an April letter to CMS, for the example, the American Hospital Association said current models for ACOs won’t be sustainable in the long run unless CMS makes significant changes to encourage more provider participation. The hospital group said the ACO programs “place too much risk and burden on providers with too little opportunity for reward in the form of shared savings.”
CMS said Pioneer ACOs in their second year showed improvements in three areas: financial, quality of care, and patient experience. Pioneer ACOs generated total model savings of more than $96 million and at the same time qualified for shared savings payments of $68 million, according to the agency. They also saved the Medicare Trust Fund about $41 million.
Pioneer ACOs also had lower per capita growth in spending for the Medicare program at 1.4 percent, which is about 0.45 percent lower than Medicare fee-for-service, the agency said. Eleven Pioneer ACOs earned shared savings, three generated shared losses, and three elected to defer reconciliation until after the completion of performance year three, it added.
The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013. The organizations showed improvements in 28 of the 33 quality measures, CMS said. The Pioneer ACOs improved the average performance score for patient and caregiver experience in six out of seven measures, according to the agency.
Positive Caregiver Experience
“These results suggest that Medicare beneficiaries who obtain care from a provider participating in Pioneer ACOs report a positive patient and caregiver experience,” it said.
CMS also reported results from year one of the Shared Savings Program ACOs, finding 53 ACOs held spending $652 million below their targets and earned performance payments of more than $300 million as their share of program savings.
The Medicare trust fund will save about $345 million, including repayment of losses for one ACO, CMS said. An additional 52 ACOs reduced health costs compared with their benchmark, but they didn’t qualify for shared savings, as they didn’t meet the minimum savings threshold, it added.
Shared Savings Program ACOs also improved on 30 of 33 quality measures, CMS said. Quality improvement was shown in such measures as patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctor, health promotion and education, screening for tobacco use and cessation, and screening for high blood pressure, the fact sheet stated.
CMS said that in 2013, more than 125,000 eligible professionals who were ACO providers or suppliers qualified for incentive payments for reporting their quality of care through the Physician Quality Reporting System (PQRS). These providers will avoid the PQRS payment adjustment in 2015 because they demonstrated the ability to report quality measures through their ACO, the agency stated.
Takeaway: For laboratories that have been sitting on the sidelines waiting to see if ACOs actually work, this may be a sign that it’s time to get involved with an ACO.
