Pioneer accountable care organizations (ACOs) and Medicare Shared Savings Program (MSSP) ACOs have saved $372 million to date and provided participants $445 million in bonuses, the Centers for Medicare and Medicaid (CMS) reported this week.
The results came from preliminary quality and financial results from the second year of 23 pioneer ACOs, and from the first year of 220 MSSP ACOs. Sixty-four (64) ACOs earned a total of $445 million in bonuses for their efforts to reduce the costs of care while improving clinical outcomes for Medicare beneficiaries enrolled in them. (“ACOs Save Medicare $372 Million,” HFMA Weekly News, September 19, 2014)
A Health and Human Services Fact Sheet reported the following:
Pioneer ACO Performance Year 2 Results
Pioneer ACOs showed improvements in three key areas: financial, quality of care, and patient experience.
Financial:
- During the second performance year, Pioneer ACOs generated estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million. They saved the Medicare Trust Fund approximately $41 million. The total model savings and other financial results are subject to revision.
- Pioneer ACOs achieved lower per capita growth in spending for the Medicare program at 1.4 percent, which is about 0.45 percent lower than Medicare fee-for-service.
- Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.
Quality of Care and Patient Experience:
- The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013.
- The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures. These measures included screening for future fall risk, screening for tobacco use and cessation, patient experience in health promotion and education, and controlling high blood pressure.
- The Pioneer ACOs improved the average performance score for patient and caregiver experience in 6 out of 7 measures. These results suggest that Medicare beneficiaries who obtain care from a provider participating in Pioneer ACOs report a positive patient and caregiver experience.
Medicare Shared Savings Program Performance Year 1 Results
- 53 Shared Savings Program ACOs held spending $652 million below their targets and earned performance payments of more than $300 million as their share of program savings. One ACO in Track 2 overspent its target by $10 million and owed shared losses of $4 million. The Medicare Trust Funds will save about $345 million, including repayment of losses for one Track 2 ACO.
- An additional 52 ACOs reduced health costs compared to their benchmark, but did not qualify for shared savings, as they did not meet the minimum savings threshold.
- Shared Savings Program ACOs improved on 30 of 33 quality measures. Quality improvement was shown in such measures as patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctor, health promotion and education, screening for tobacco use and cessation, and screening for high blood pressure.
- Shared Savings Program ACOs achieved higher average performance rates on 17 of the 22 Group Practice Reporting Option Web Interface measures reported by other Medicare FFS providers reporting through this system.
- In 2013 alone, over 125,000 eligible professionals who were ACO providers or suppliers qualified for their incentive payments for reporting their quality of care through the Physician Quality Reporting System (PQRS) These providers will also avoid the PQRS payment adjustment in 2015 because they demonstrated the ability to report quality measures through their ACO.
“In addition to the savings attributed to these new payment models, quality and patient experience scores improved as well,” said a Healthcare Financial Management Association executive. “These results demonstrate the commitment of these participants to greater collaboration with each other in a number of areas, as well as a continued focus on keeping patients healthy rather than treating them when they were sick.” (“ACOs Save Medicare $372 Million,” HFMA Weekly News, September 19, 2014)
Read the CMS press release here.
iProtean subscribers, Physicians and the New Healthcare Business Model is in your library. Featuring Todd Sagin, M.D., J.D. and Larry McEvoy, M.D., this course takes an in-depth look at the physician perspective of the new healthcare business model, and offers suggestions to boards on how to work with physicians to accomplish a successful transition to this model.
Our next advanced course, due in your library at the end of October, features noted governance experts Barry Bader and Pam Knecht.
iProtean subscribers, Physicians and the New Healthcare Business Model is in your library. Featuring Todd Sagin, M.D., J.D. and Larry McEvoy, M.D., this course takes an in-depth look at the physician perspective of the new healthcare business model, and offers suggestions to boards on how to work with physicians to accomplish a successful transition to this model.
Our next advanced course, due in your library at the end of October, features noted governance experts Barry Bader and Pam Knecht.
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