The trusted source for
healthcare information and
The numbers are in for this year’s look at the experimental Pioneer Accountable Care Organization: While there are more ups than last year, Pioneer ACOs also had their share of downs.
While 32 organizations were originally selected to be Pioneer ACOs, that number is now down to 23. The Affordable Care Act established the experimental ACOs to test the model to cut costs to physicians and Medicare through quality improvement. Physicians are reimbursed on the basis of quality, rather than volume.
According to numbers released by the Centers for Medicare & Medicaid Services http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-09-16.html:
And, as I was writing this, news broke that three more ACOs decided to leave the Pioneer program http://www.modernhealthcare.com/article/20140925/NEWS/309259938?AllowView=VDl3UXk1T3dDUEdCbkJiYkY0M3hlMHFyaWtVZENlND0=&utm_source=link-20140925-NEWS-309259938&utm_medium=email&utm_campaign=mh-alert . One company, Franciscan Alliance, plans to join the Medicare Shared Savings ACO program.
So the question remains: If the savings numbers are going up, what’s causing organizations to leave? The way Medicare benchmarks payments, including disproportionate-share hospital payments, is an issue, Sharp CEO Alison Fleury told California Healthline. So while the ACO was hitting quality improvement targets, the payment formulas meant that the organization was going to break even rather than share in savings and bonuses. Michigan-based Genesys PHO, which just announced its exit, also cites the payment model as a detriment. The organization faced penalties in both years of the program.