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Evaluating ACOs at Mid-Launch

19 Responses

1. Kendall, on May 12, 2012 at 11:47 AM said:

   CMS expands medical staff definition to include APRNs and PAs

   Among a raft of changes the Centers for Medicare & Medicaid Services issued this week, the agency controversially expanded its definition of the medical staff, allowing nonphysician practitioners to have privileges like other medical staff members. In an effort to cut some outdated requirements, CMS changed rules about medical staff oversight and roles.

   Click to access 2012-11548_PI.pdf

   Any thoughts?

   Kendall

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2. Jane, on June 5, 2012 at 10:33 AM said:

   On ACOs and Unicorns

   I just don’t think they are going to make it.

   http://www.fiercehealthcare.com/story/acos-and-unicorns-lovely-elusive/2012-05-31

   Like unicorns; lovely but elusive!

   Jane

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3. Ann Miller RN MHA, on June 8, 2012 at 9:54 AM said:

   Medicare ACO Participants Hit Firewall

   The earliest participants in Medicare’s high-profile accountable care organization program have experienced problems accessing needed CMS data during their first six months of operations, according to the head of the agency.

   Marilyn Tavenner, acting administrator of the CMS, told ACO advocates, experts and providers at a Washington conference Thursday that the agency was working to streamline ACO participants’ access to their Medicare enrollees’ data after some of them experienced delays in receiving that information. Rapid and comprehensive sharing of patients’ clinical data between providers is a fundamental building block of ACOs.

   Source: Rich Daly, Modern Healthcare [6/7/12]

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4. Ann Miller RN MHA, on October 8, 2012 at 11:27 PM said:

   ACOs produce little healthcare savings

   It’s disappointing news for the architects and participants of accountable care, hoping that the alternative payment model would curb healthcare spending.

   http://content.healthaffairs.org/content/early/2012/10/02/hlthaff.2012.0385

   A new Health Affairs study found that Medicare accountable care organizations (ACO) that improved diabetes outcomes by as much as 10 percent had little to no effect on costs savings.

   Ann Miller RN MHA

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5. Laura Paden, on November 15, 2012 at 2:34 PM said:

   Momentum for bundled payment programs continues to build

   According to analysis by the Congressional Budget Office, bundling payments for hospital and post-acute care for the Medicare population could save an estimated $19 billion over a 10-year period.

   So, it’s not surprising that health plans and providers across the country are beginning to experiment with developing or implementing bundled payments for specific services and procedures.

   Laura Paden

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6. Shahid N. Shah MS, on December 20, 2012 at 3:58 PM said:

   Care Coordination Technologies Will Catch On

   Care coordination will become more prominent;

   “because new business models like ACOs will require them. Such coordination, as opposed to record sharing through EHRs, is really tough because workflows have to be worked out between different legal entities across providers. We have a long way to go to really implement seamless coordination even though we have the basic technologies available to do so now.”

   Shahid N. Shah MS
   via Ann Miller RN MHA

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7. Hope Hetico RN MHA, on March 22, 2013 at 10:01 AM said:

   Clinical Integration Beyond ACOs: The New Frontier

   The Federal Trade Commission (FTC) recently released an advisory opinion approving the May 26, 2011 proposal for clinical integration of Norman Physician Hospital Organization (Norman PHO). The approval of Norman PHO’s integration plan represents the “first advisory opinion on a proposed clinically integrated network (CIN) since the [Affordable Care Act] was enacted.”

   Click to access ACO.pdf

   The FTC noted the plan’s potential to increase interdependence and cooperation among providers, increasing efficiency without significant encroachment on market competition. The novel decision provides guidance to other provider networks that may choose to forego an ACO model in lieu of alternate CIN structures.

   Hope Hetico RN MHA
   via HealthCapital.com

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8. Dr. Mina, on April 24, 2013 at 1:55 AM said:

   ACOs

   Clayton Christensen, a Harvard Business School professor, uses the term “disruptive innovation” to describe how “complicated, expensive products and services are eventually converted into simpler, affordable ones.”

   In a recent Wall Street Journal column, Christensen and his co-authors argued that accountable care organizations, or ACOs, can’t make a dent in costs because they won’t fundamentally disrupt and transform the delivery of American healthcare.

   http://online.wsj.com/article/SB10001424127887324880504578296902005944398.html

   Any thoughts?

   Dr. Mina

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9. Dr. Gordon, on May 3, 2013 at 6:12 PM said:

   Three Different Paths to Bundled Payments

   According to Bill Santamour, there are three very different payment models health care organizations may use to blaze their own trails to a new reimbursement model.

   http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=5190005766

   What are the lessons learned and common themes that have emerged so far?

   Dr. Gordon

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10. Dr. David Edward Marcinko MBA, on July 17, 2013 at 10:31 AM said:

    Pioneer ACO Program Results

    Why Saving Money for CMS Doesn’t Mean the Business Model is Viable.

    http://diseasemanagementcareblog.blogspot.com/2013/07/pioneer-aco-program-results-why-saving.html

    Dr. David Edward Marcinko MBA

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11. Ann Miller RN MHA, on August 13, 2013 at 10:00 AM said:

    Without incentives, doctors won’t treat via email

    Even though patients are clamoring for it and health organizations see its benefits, electronic communication from primary care physicians won’t become commonplace until doctors’ workloads are reduced — or until they get paid extra.

    http://www.healthcarefinancenews.com/news/incentives-needed-doctors-email?topic=05,21,24

    Ann Miller RN MHA

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12. Lester, on August 20, 2013 at 11:26 AM said:

    ACOs

    Is there any proof that ACOs or PCMHs will improve the quality or cost of care?

    Lester

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13. Earl, on January 31, 2014 at 2:01 AM said:

    Medicare Accountable Care Organization Savings

    According to the Centers for Medicare & Medicaid Services (CMS) savings from both the Medicare ACOs and Pioneer ACOs exceed $380 million.

    While ACOs are designed to achieve savings over several years, not always on an annual basis, the interim financial results released for the Medicare Shared Savings Program ACOs show that, in their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first 12 months, 29 generated shared savings totaling more than $126 million – a strong start this early in the program. In addition, these ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. ACOs share with Medicare any savings generated from lowering the growth in health care costs while meeting standards for high quality care. Final performance year-one results will be released later this year.

    An independent preliminary evaluation of the Pioneer ACO Model – the ACO model designed for more experienced organizations prepared to take on greater financial risk shows Pioneer ACOs generated gross savings of $147 million in their first year while continuing to deliver high quality care. Results showed that of the 23 Pioneer ACOs, nine had significantly lower spending growth relative to Medicare fee for service while exceeding quality reporting requirements. These savings far exceed findings from a previous analysis conducted by CMS, which used a different methodology.

    Source: U.S. Department of Health & Human Services

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14. Nancy, on January 31, 2014 at 1:02 PM said:

    Another Opinion

    Earl – The First crop of Medicare ACOs face exchange problems

    Some of the early Medicare ACOs and the federal government have improvements to make the coming years, especially when it comes to sharing data, this new survey suggests.

    http://www.hiewatch.com/news/first-crop-medicare-acos-face-exchange-problems

    Nancy

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15. Ann Miller RN MHA, on June 24, 2014 at 12:13 PM said:

    Someone is noticing the problems with ACOs

    According to our colleague Tom McGuinness, CPA, CVA – Founding Partner, Reimer, McGuinness & Associates, P.C and the Centers for Medicare and Medicaid Services (CMS), the American Hospital Association (AHA) sent a letter in April to CMS discussing many issues/problems with both the Pioneer Model of ACO and Medicare Shared Savings Program (MSSP) and the challenges faced by participants.

    http://www.medicalpracticeinsider.com/blog/someone-noticing-problems-acos

    The six-page letter is an astute commentary on the plight of delivery systems trying to bridge the gap from patient-or insurance-based payment and shared savings on cost reductions to population-based payment models ….… the latest name for full-risk (global) capitation models.

    PS: Tom contributed to our book on financial planning for doctors and their advisors.

    Ann Miller RN MHA

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16. William J DeMarco MA CMC, on June 30, 2014 at 5:51 PM said:

    On ACOs

    We have been working with bundled payments since 2001 using our episodes of care and Medicare bundling process. We see that in several locations the results have been successful and in some areas these efforts never really got off the ground. When the efforts have been successful, it is usually because the providers have been taking some risk contracts and have the ability to track and re-engineer the bundled payments to fit a specific specialty or service arrangement such as Cardiology, Orthopedics, Oncology or Ophthalmology.

    These bundles usually include hospital, physician and ancillary arrangements and are tiered using severity and diagnosis of patients. The unsuccessful ones seem to happen when they are hospital only packages, as the hospitals can set limits on charges but lose a lot of the clinical data because the doctors are not involved.

    Physicians charging global services through their MSOs or IPAs have come a long way. We see this trend continuing with physician groups choosing the less costly and most successful hospitals. As more payers and providers are willing to take back some shared savings we see bundles to be a core strategy for hospitals, physicians and payers to collaborate. We think once vendors start seeing the advantage of evolving to this kind of billing and tracking process there will be a new version of practice management, EMR and billing systems from which to choose.

    However, the key to success will be follow-up care, coordination, as well as a correct diagnosis the first time. By reporting quality data this will help differentiate the payer/provider relationship in the marketplace and all of this adds to savings and patient /enrollee market share growth.

    William J DeMarco MA CMC
    [President/CEO]
    Pendulum HealthCare Development Corporation

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17. Ann Miller RN MHA, on July 22, 2014 at 12:05 PM said:

    New Quality Measures Proposed for Medicare ACO Program

    Accountable care organizations (ACOs) that participate in the Medicare Shared Savings Program (MSSP) will face a new set of quality measures in 2015 under the proposed Medicare Part B payment rules of the Centers for Medicare & Medicaid Services (CMS). Twelve new measures will be added and 8 current metrics will be eliminated, yielding a set of 37 measures, 4 more than the current 33. The approximately 300 ACOs in the MSSP must report on these quality measures and reach a certain threshold of performance in order to share fully in any savings they produce for CMS.

    If the proposal is finalized in its current form, ACOs would have to use the new quality measures for the 2015 reporting period and would report the data to CMS in 2016. Under the 3-year MSSP contracts, ACOs are rewarded for complete and accurate reporting in the first year; after that, they must demonstrate a certain level of performance to get their full bonuses.

    Source: Ken Terry, Medscape News [7/18/14]

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18. Henry Loubet, on October 30, 2014 at 5:33 PM said:

    ACOs

    The recent withdrawal of nearly 40% of the Pioneer ACO participants is indicative of significant concern but does not represent the systemic failure of the model. While these Medicare ACO programs did not perform as well as hoped, there were many factors affecting savings and quality improvements including geography and diversity of the populations served.

    A recent article published by the Brookings Institute analyzes the two-year results in some depth and that many of the ACOs continuing to participate in the Pioneer ACO program are achieving notable success. In the California marketplace, Brown & Toland Physicians and Monarch HealthCare were among the better performing ACOs in the study.

    ACOs continue to demonstrate great promise on the commercial side. Anthem Blue Cross and Blue Shield of California have been leading the way in California in taking the ACO model to the next level.

    For more than 20 years, the delegated/capitated model of health care delivery has been in existence in California, and it is not surprising that two of the largest health plans have been behind the development of successful ACO structures. Anthem’s ACO has seen increases in HEDIS quality metrics and patient engagement. Blue Shield continues to expand the geographic reach of its ACOs, adding a number of new medical groups to the program. ACO efforts between CalPERS/Dignity, Hill Physicians and Blue Shield can also be classified as successful ACOs. In addition, the Kaiser Permanente integrated care model that ACOs emulate has been in existence here since the 1940s.

    Certainly adjustments to procedures, the structure of incentives and improved alignment between the cost and quality of health care are needed to achieve the highest objectives of the Accountable Care model. These changes take time and some organizations will be able to improve their performance better than others.

    Far from being a systemic failure, the ACOs that have shown dedication to the model are showing that the program is having some successes and have demonstrated that improvement in financial and quality outcomes are possible within a reasonable time horizon.

    Henry Loubet
    http://www.henryloubet.com/

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19. Ann Miller RN MHA, on September 14, 2015 at 10:32 PM said:

    UPDATE: 6 Things to Know about 2014 MSSP ACO Performance

    1. Ninety-two Shared Savings Program ACOs held spending $806 million below their targets and earned performance payments of more than $341 million as their share of program savings
    2. No MSSP ACOs owed CMS
    3. While total savings increased from 2013, the avg savings payments per MSSP ACO decreased ( $8.76 million per ACO in 2014 vs. $12.16 million in 2013
    4. An additional 89 ACOs reduced health care costs compared to their benchmark in 2014, but did not qualify for shared savings
    5. Among ACOs that entered the program in 2012, 37% generated shared savings, compared to 27% entering in 2013, and 19% entering in 2014
    6. Shared Savings Program ACOs that reported in both 2013 and 2014 improved on 27 of 33 quality measures

    Source: CMS Fact Sheet, Medicare ACOs Provide Improved Care While Slowing Cost Growth in 2014

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