On August 25, the Centers for Medicare & Medicaid Services
(CMS) released information on the 2014 quality and
financial performance results for the accountable care
organizations (ACOs) participating in the Pioneer model
("Pioneer ACOs") and the Medicare Shared Savings Program
("MSSP ACOs").
Since the launch of the Pioneer model in 2012, Pioneer ACOs have
been required to assume some risk of financial losses in order to
receive a portion of shared savings (referred to as two-sided
risk). In contrast, MSSP ACOs are able to chose from two payment
models: Track 1, which allows payment for shared savings (one-sided
risk), or Track 2, which provides greater opportunity to share in
any savings in exchange for the MSSP ACO agreeing to share
responsibility with CMS for possible financial losses (two-sided
risk). According to CMS, there were only three MSSP
ACOs participating in Track 2 in 2014.
The results recently released by CMS show that for the 20 Pioneer
ACOs that participated in the program in 2014 (which was
Performance Year 3), 15 generated savings and 11 (55%) produced
enough savings and achieved the requisite quality metrics to earn
shared savings. Three Pioneer ACOs are required to pay CMS for
shared losses. In contrast, the results indicate that for the 404
MSSP ACOs participating in Tracks 1 and 2 in 2014, only 333
generated any savings and only 92 (22.7%) achieved savings and met
the threshold quality performance goals. None of the three Track 2
MSSP ACOs owe CMS payments for losses. Based on these results, CMS
concluded that "...ACOs with more
experience in the program tend to perform better over
time."
However, is experience the only explanation for the results?
Granted, most of the Pioneer ACOs are larger, more established
healthcare organizations with the requisite infrastructure and
experience in managing cost and quality of care. But does that
entirely explain the difference between 55% of the Pioneer ACOs
performing at the level necessary in order to achieve shared
savings versus only 22.7% of the MSSP ACOs doing so? Or the fact
that none of the Track 2 MSSP ACOs owed CMS for losses? It appears
that additional analysis is required to determine how, if at all,
having financial risk affects the performance of the ACOs
participating in Medicare models. This expanded analysis is
particularly important in view of CMS's recent change
(discussed
here) which allows MSSP ACOs to continue in Track 1 with
one-sided risk for another three-year contract term, rather than
being required to transition to Track 2 with two-sided risk.
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