Medicare Accountable Care Organizations

Medicare Accountable Care Organizations had $411 million in total savings in 2014, but few of the Pioneer and Medicare Shared Savings Program (MSSP) ACOs qualified for bonuses in the program’s second year,  say the latest data from the Centers for Medicare & Medicaid Services (CMS).

CMS reported that only 97 of the 20 Pioneer ACOs and 333 MSSP ACOs qualified for shared savings payments  by meeting quality standards and their savings threshold. Still,  the  results indicated that the ACOs with more experience in the program tend to perform better.

Some observers  say that the CMS benchmarks to win savings rewards are too rigid, with the perfect being the enemy of the good.

Clif Gaus, chief executive officer of  the National Association of ACOs,  complained:

“This is not a sustainable business model for the long-term future. With Medicare cost growth at record lows, now is the time for the government to invest in and support a national effort for population-based coordinated care and not just take, or be satisfied with, savings from a minority of ACOs at the risk of the majority of ACOs abandoning the program.”

He estimated that  40 to 50 ACOs will leave the MSSP program this year unless the government takes steps to improve the program, including changing the risk-adjustment formula, setting  target benchmarks, eliminating the ‘penalty-only’ quality scoring and providing financial rewards for improving quality.