ACOs Join in Medicare Shared Savings Program

Starting in January, there will officially be an additional 123 accountable care organizations (ACOs) in the Medicare Shared Savings Program. As providers and hospitals transition to this emerging care model, there is mixed opinion over its longevity.

Marc Manley, MD, the vice president, population health management for the Insurance Services Division at the University of Pittsburgh Medical Center says that while the industry has entered “an era of big transition” to a value-based system, it is still competing with volume-based incentives.

“The bad news is that we’re operating two systems at the same time: Payment is still being done on volume while some reward is being offered for delivering higher value care and cost savings,” he says. “. “Many hospitals still believe that getting more people into the ER is a good thing financially, but payers don’t agree. That’s a sign that the financial incentives are not aligned. The physicians may already realize that they could offer longer clinic hours instead of forcing patients to use the ER. That’s another sign that incentives are misaligned.”

Medical groups choosing to participate in ACOs have an opportunity to earn financial bonuses for meeting quality benchmarks, including those which enhance the patient experience and improve care for at-risk populations. Several groups have even chosen to rejoin an ACO after initially leaving the Pioneer program over the summer. An estimated 1.5 million additional Medicare beneficiaries are expected to benefit from the recent influx in participation.

“This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care,” HHS Secretary Kathleen Sebelius said in a statement.

Around the Web

HHS Adds 123 Medicare ACOs, With About 1.5 Million Beneficiaries [Modern Healthcare]

Managing the Shift from Volume to Value [Healthcare Finance News]