The Centers for Medicare & Medicaid Services (CMS) has announced that nine of the 32 pioneer accountable care organizations (ACOs) will leave the experimental program, which began January 1, 2013. CMS also confirmed that seven did not produce savings and intend to apply to the alternative ACO model, the Medicare Shared Savings Program (MSSP), and two others have told CMS they are leaving the program completely.
ACOs are organizations formed by groups of doctors and other healthcare providers that have agreed to coordinate care for Medicare beneficiaries at a lower cost to Medicare. Provider participation in an ACO is voluntary. The pioneer ACOs agreed to a three-year plan that includes a fixed monthly payment instead of receiving traditional fee-for-service payments.
However, after the first year of participation, the 32 pioneer ACOS sent a letter to the Center for Medicare and Medicaid Innovation which stated that while they are committed to the aims of the program, they are requesting that the quality benchmarks the ACOs have to meet to qualify for Medicare bonuses be revised. The pioneer ACOs noted that 19 of 31 quality measures were set without anchoring methodology, reflecting a lack of data. Quality measures relate to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. They also suggested some proposed benchmarks are too high.
For more information about ACOs, visit the CMS website.