Medicare ACO results show some success, need for change

The early evidence on accountable care organizations in the Medicare Shared Savings Program (MSSP) indicates that while these ACOs have made some headway in savings and care quality, changes to the program could make them more successful, according to Health Affairs.

While most MSSP ACOs achieved relatively small savings or losses, a large portion of ACOs saved rather than overspent relative to their benchmarks, indicating at least some degree of success, one analysis states.

The size of the ACO didn't necessarily determine its likelihood of producing savings, as large ACOs "generally did not have an advantage in financial performance compared to smaller ACOs," according to the article.

But geography does appear to play a role in ACOs' financial success, as ACOs in the South performed better on average than other regions, and those in high-cost areas were particularly successful in producing savings. The other analysis expands upon this finding, concluding that "the way medicine is practiced (or at least has been practiced) in a region is important to the ACO's ability to generate shared savings under current benchmarking methodology."

Financial performance, though, is only one part of ACOs' overall mission, and the first Health Affairs analysis notes that the savings produced by MSSP ACOs is not necessarily related to how they were able to improve the quality of care. Many ACOs that showed high quality performance also produced savings, but the two factors aren't highly correlated, indicating that the Centers for Medicare & Medicaid Services (CMS) could do more to improve the link between the two measures of success.

"Organizations that can improve care and lower costs need a clearer and more sustainable path beyond the current two tracks," the analysis concludes.

Improving the model is precisely what CMS intended in its recently proposed rule change that aims to give MSSP ACOs an extra three years before they could face penalties for poor performance and offers a new model to entice providers to form ACOs, FierceHealthcare has reported. But the CMS proposal may not go far enough to address concerns of participating ACOs that are struggling to comply with the rules of the program and report quality measures, health economist Paul Keckley, Ph.D., recently told FierceHealthcare.

 "I think the two things that are pretty clear is the CMS wants the ACOs to stay alive," Keckley said. "The second is the changes don't address some of the things that the ACOs are currently participating would like to have seen."

The American Hospital Association has also criticized CMS' rule change proposal, saying the kickback prevention measures it includes--particularly rules governing the transportation of patients--could impede healthcare delivery, according to FierceHealthFinance.

To learn more:
- read the first analysis
- check out the other analysis