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Pioneer ACOs threaten to walk

CMS head Marilyn Tavenner agrees to discuss demands for benchmark revisions
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The Pioneer accountable care organizations have asked the Center for Medicare and Medicaid Innovation to revise quality benchmarks the ACOs have to meet to qualify for Medicare bonuses, threatening to drop out of the program otherwise.

The Pioneer ACOs note 19 of 31 quality measures were set without anchoring methodology, reflecting a lack of data, according to a letter sent Feb. 25 and posted online by The Washington Post. The Pioneer and Medicare Shared Service Program ACOs suggest they can provide data to better inform the selection of empirical benchmarks.

The Pioneer ACOs also suggest some proposed benchmarks are too high, including those based on data from Medicare Advantage. "We believe there are fundamental differences between the experience of non-managed and managed populations that warrant consideration when establishing pay-related benchmarks," they wrote.

They "strongly recommend" Pioneer ACOs remain in reporting-only status for performance year 2013 so benchmarks can be rebuilt for 2014 performance. They requested a decision before April 2.

The letter was first reported by Inside Health Policy, which noted Wednesday that CMS Acting Administrator Marilyn Tavenner said she will meet this month with the Pioneer ACOs to discuss their demands.

"We all feel like we're pioneering an effort to convert our health care system from purely volume-based to a more value-based approach," Jim Hinton, CEO of Presbyterian Health Services in New Mexico, one of the Pioneer ACOs, told The Washington Post's Health Reform Watch blog. "So like any programs of a new size, there have been some start up and transition issues."

To learn more:
- read the ACOs letter
- here's the blog post
- see the Inside Health Policy follow up (subscription required)

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