Most accountable care organizations reported "significant" ongoing costs of operation and even more plan to leave the program if ACOs are excluded from a federal list of alternative payment models proposed as part of the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA).
Those are the findings of a new survey published by The National Association of Accountable Care Organizations (NAACOS) that looked at ACO operational costs, ACOs' ability to take on downside risk and the current proposed rule for MACRA.
Researchers surveyed 144 ACOs of various sizes across 40 states and found about 8 in 10 respondents work with ACOs that are either physician-owned or owned by a partnership between a physician and a hospital. A slight majority (51 percent) said their operating costs were "very significant," compared to only 6 percent who said they were either negligible or nominal.
On average, respondents report annual operating costs of $1.6 million, but single ACOs average far higher costs (under $2 million) than multi-ACO systems (nearly $1 million) per year.
Fifty-six percent of those surveyed said they were very or somewhat unlikely to remain in the Medicare Shared Savings Program if the Centers for Medicare & Medicaid Services goes forward with plans under MACRA to exclude Track 1 ACOs from a list of approved alternative payment models. Multi-ACOs are more likely to remain in the program, even if they find themselves forced to take on more downside risk, according to the survey.
"This study raises very serious concerns about the long-term viability of the Medicare ACO program under the current risk models and proposed MACRA policies," NAACOS President and CEO Clif Gaus said in a statement.