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The numbers are in for this year’s look at the experimental Pioneer Accountable Care Organization, and while there are more ups than last year, Pioneer ACOs also had their share of downs.
The Pioneer ACO program began in 2012 with 32 organizations, though nine dropped out or moved to the Medicare Shared Savings ACO program in 2013. The new numbers reflect the performance of the remaining 23 ACOs throughout 2013 -- but that number has just been reduced again. 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:
As I was writing this, Modern Healthcare reported that three more ACOs decided to leave the Pioneer program, and that one of those companies plans to join the Medicare Shared Savings ACO program.
Now 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 HealthCare explained in financial statements. 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. It is possible the other ACOs exited for similar reasons: That while they were performing well, saving money for Medicare, and hitting quality targets, they were not sharing in the savings and were, in fact, sharing in losses from other ACOs.
Looks like the Pioneer ACO program still has a long way to go.