Fewer than one-third of ACOs qualify for Medicare bonuses

Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.

And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.

CMS and Congress must "take swift and decisive action to solidify the foundation of the Medicare ACO program," Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.

The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.

The National Association of ACOS "was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs," Clif Gaus told FierceHealthcare via email, adding, "the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment." 

ACOs participating in the past two years improved on 84 percent of the quality performance measures used. Average quality performance increased by 15 percent on key preventive care measures for fall, depression and blood pressure screenings and follow-ups.

ACOs have created significant financial impacts by aligning financial incentives with improved care coordination. Though the cohort of Pioneer ACOs shrunk from 2014 to 2015, the model still resulted in savings of $37 million, according to the fact sheet.

A new “final rule” instituted by CMS in June factors ACOs’ capacity to deliver quality care at lower cost relative to local competitors into ACOs’ reimbursement. The rule change ends the previous practice of reimbursing ACOs based on past performance evaluations, FierceHealthcare reported.

The sometimes tumultuous path of ACOs embodies the stop-and-go progress of the transition to a value-based care payment system. Recent high-profile exits from RiverHealth and WakeMed dampened hopes for Next Generation ACOs.