On July 16, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a press release summarizing the performance results for the first year of the Pioneer Accountable Care Organization (ACO) Model. Made possible by the Patient Protection and Affordable Care Act (PPACA), the Pioneer ACO Model encourages providers and care givers to deliver more coordinated care ans services for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely, according to CMS.
Pioneer Model ACOs Increase Quality.
The press release states that all thirty-two (32) participants in the program successfully increased the quality of care received by their beneficiaries. Consequently, each participant received incentive payments for achieving these results.
Some examples of the quality improvements were lower readmission rates and better blood pressure and cholesterol control among diabetic patients. Some examples of the quality control measures that were implemented were:
– dispatch of hospital trained nurses to beneficiaries’ homes for management of prescriptions, blood-sugar readings, healthy eating education and delivery and set up of durable medical equipment (DME); and
– care coordination by trained healthcare professionals at no cost.
Pioneer Model ACOs Increase Savings.
Of the thirty-two (32) Pioneer ACOs, thirteen (13) of them produced shared savings with CMS. This means that they exceeded the cost reduction benchmarks and were eligible to receive a percentage of those savings from CMS as compensation additional to the fee-for-service payments. In total CMS estimates that approximately $87.6 million in Medicare expenditures was saved.
However, two (2) of the Pioneer ACO participants had shared losses. This means that their per beneficiary fee-for-service expenditures exceeded the stated goal and they were required to share in the losses suffered by CMS. These losses were approximately $4 million.
Some Pioneer Model ACOs Withdrawal From Program.
Of the Pioneer ACOs that did not produce shared savings, seven (7) of them have decided to leave the Pioneer program and enroll in the standard Medicare Shared Savings Program. This program offers lower risks and lower rewards and does not have the option of moving to a capitated payment model after the first two (2) successful years.
The two (2) Pioneer ACOs that experienced shared losses with CMS have signaled their intent to withdraw from the ACO model entirely.
The First-Year Pioneer ACO Lesson: Win Some, Lose Some.
While not a total success, the Pioneer ACO program did manage to produce net savings to Medicare and improve the quality of care provided to its beneficiaries. Many news outlets who oppose PPACA are citing this as a failure of the program and yet more bad news for President Obama’s healthcare overhaul. However, many other sources share CMS’s somewhat rosier view of the program. These sources state that while the program may not have been as big a success as hoped, it was only the first year in operation and is nowhere near a failure.
According to an article in American Medical News, the American Medical Association (AMA) supports ACO programs that have allowed physicians practicing in groups of various sizes to participate in new care models. The AMA states that the first-year pioneer results are encouraging, and have the potential to improve quality and decease costs. To read the entire article from American Medical News, click here.
Data should be released on the standard Shared Savings Program ACOs in the near future.
Contact Health Law Attorneys Experienced With Healthcare Business Practices.
The Health Law Firm routinely represents physician groups and practices with issues involving establishing, licensing, selling, merging, and intergroup affiliation. If you are considering establishing an ACO or have been approached to become a participant in one, you can contact The Health Law Firm at (407) 331-6620 or (850) 439-1001 or you can visit our website at www.TheHealthLawFirm.com.
What do you think of the performance results summery for the first year Pioneer ACO Model? What do you think about the number of groups dropping out? Please leave any thoughtful comments below.
Centers for Medicare and Medicaid Services. “Pioneer Accountable Care Organizations Succeed in Improving Care, Lowering Costs.” CMS.gov. (July 16, 2013). From: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html
Fiegl, Charles. “Medicare pioneer ACOs save money but lose physicians.” American Medical News. (July 29, 2013). From: http://www.amednews.com/article/20130729/government/130729933/1/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130729
About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
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