Despite their early successes, accountable care organizations (ACOs) remain an uncertain prospect within healthcare, MedPageToday reports.
Although a recent report from the Centers for Medicare & Medicaid Services showed Medicare ACOs improved in both quality and savings their second year, three additional ACOs left the Pioneer program this week, leaving just over half of the original 32 participants.
Despite the encouraging results from CMS, 52 ACOs, while they met cost-reduction benchmarks, failed to save enough to qualify for shared savings. For example, the Dean/St. Mary's ACO in Madison, Wisconsin, lost nearly $10 million overall with about $4 million in shared losses but remains in the program.
"According to the CMS report, Medicare members in the Dean/St. Mary's ACO have become healthier over time and our cost of care has remained well below the national average," Paul Reber, D.O., medical director for the Dean/St. Mary's ACO, told MedPageToday. "However, due to the complex payment methodology in the Medicare Shared Savings Program, we were unable to meet all of the necessary benchmarks."
Other ACOs fared better due to experience with high-risk models. Glendale, California-based ApolloMed saved nearly $11 million, including about $5.5 million shared savings, according to the article. Apollo Medical Holdings Chairman Gary Augusta credited the ACO's success in part to Apollo already running several other business units that prepared it for working with physicians and a fixed budget for patient care, such as its hospitalist business and independent practice association.
The CMS results indicate that while ACOs have great potential to help reform the healthcare model, it also demonstrates that it will be an arduous, gradual process, Stuart Guterman, vice president for Medicare and cost control at the Commonwealth Fund, told MedPageToday.
"We're still learning how to improve on the current system, but there does seem to be a general reaction among healthcare providers that there's something going on that requires them to look differently at how they operate," Guterman said.
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