Two more Pioneer ACOs may leave over financial woes

Two more participants may exit the Pioneer ACO program due to lackluster financial performance--just days after the Centers for Medicare & Medicaid Services announced its accountable care organizations saved $411 million last year.

New Hampshire's Dartmouth-Hitchcock Medical Center, despite achieving better than average care quality scores, posted a loss for two consecutive years, prompting leaders to seriously consider leaving the Pioneer program, Robert A. Greene, M.D., the ACO's executive vice president and chief population health management officer, told Healthcare Finance News. A final decision is still pending, he said. The deadline to leave the program is Sept. 14.

Greene added that even if Dartmouth-Hitchcock elects to leave, it may join CMS' newer Next Generation model by the end of 2015. He said the ACO owes CMS $3.6 million for year 3 on top of the $1.4 million it owes for year 2. Two other Pioneer ACOs owe the agency money as well, according to the article.  

Despite its financial woes, Dartmouth-Hitchcock added multiple patients and hospitals to its network under the program, increasing the patient population by 18,000 between 2013 and 2014, according to the article.

Maine's Beacon Health is also considering leaving despite earning the second-highest quality scores in the program, after Wisconsin's Belin-ThedaCare Healthcare Partners, according to another Healthcare Finance News article. Beacon also fell short of CMS' financial benchmarks, and owes the agency $2.9 million for 2014. Maine has both lower costs of care and an older patient population than the national average, making the financial benchmarks an uphill struggle, said Chief Financial Officer Jeff Sanford.

Despite the Department of Health and Human Services' announcement in May that it will expand the Pioneer program, numerous participants have already left, with the total number of exits reaching 13 as of September 2014.

To learn more:
- here's the first Healthcare Finance News article
- read the second Healthcare Finance News article