CMS confirms nine Pioneer ACOs may leave program

The Centers for Medicare & Medicaid Services has confirmed that nine of the 32 Pioneer accountable care organizations may walk away from the experiment, which is designed to change the way medical providers are paid to manage care for patients with chronic diseases, Bloomberg reports.

"The nine Pioneer ACOs have probably 20 reasons for leaving," Mark Callahan, M.D. (pictured right), CEO of Mount Sinai Hospital's ACO, Mount Sinai Care, told FierceHealthcare in an interview this morning.

The first signs of trouble came earlier this year, when the Pioneer ACOs threatened to drop out of the program unless the Center for Medicare and Medicaid Innovation revised the quality benchmarks they must meet to qualify for Medicare bonuses. In a Feb. 25 letter to CMS, the Pioneer and Medicare Shared Savings Program ACOs complained that 19 of 31 quality measures were set without anchoring methodology, reflecting a lack of data.

Now it looks like some may leave the program regardless of whether the quality measures are revised. CMS Spokesman Brian Cook confirmed that nine Pioneer ACOs have said they may exit and four of the nine may join an ACO that carries less financial risk, Bloomberg reported. The Pioneers have until July 31 to make their decision. 

Instead of receiving traditional fee-for-service payments, the Pioneer ACOs agreed to a three-year plan that includes a fixed monthly payment. The program was set up to slow the growth of rising healthcare costs, with estimates that it could save as much as $940 million through 2015.

Depending on the number of patients involved, the departure of the nine Pioneer ACOs could mean the Affordable Care Act's critical cost-containment approach is running into real problems, Robert Blendon, a health-policy professor at Harvard University's School of Public Health, told Bloomberg.

It's possible, Blendon said, that some of the ACOs may be learning that it isn't as easy as they initially thought to manage financial risk of sick patients.

But Callahan, who is also chief medical officer and associate dean for excellence in clinical care at Mount Sinai's school of medicine, told FierceHealthcare that it's too early to know what the potential departures will mean to the Pioneer program and the ACA's financial goals.

"I think some will convert to regular ACO status so they won't have the downside of the financial risk," Callahan said. "The issues around quality metrics have also raised concerns, so CMS may adjust the measures to keep the ACOs from leaving the Pioneer program."

And though Callahan acknowledges there is a risk that other Pioneer ACOs may leave the program if the nine unidentified partners depart, he says there is still hope for the Medicare Shared Savings Program. "I think the ACO shared savings program has a lot of validity," he says. "It's just too early to decide it's not going to work."

To learn more:
- read the Bloomberg report