Stephen Nuckolls Emphasizes the Importance of Transparency in ACO Benchmarks

While speaking at the National Association of Accountable Care Organizations Spring 2016 Conference, Stephen Nuckolls, CEO of Coastal Carolina Quality Care, said that fair and transparent benchmarks are important in creating successful ACO programs.

Transcript (slightly modified)

What is your view on the new ACO benchmarking rule?

This new benchmarking rule is very important. How we keep score in the Medicare ACO program is vital to our long-term business prospects. We must have fair and transparent benchmarks in order for the program to be successful, especially when it comes to groups taking downside risk. They not only have to be transparent but they also have to be very predictable in order for groups to take risk.

There are many different facets of the new benchmarking proposal that are very good. For example, with the original program, the benchmarks were adjusted based on all fee-for-service beneficiaries. Under the new rule, they have proposed that the fee-for-service comparison is just for attributable beneficiaries. And that may seem like a small distinction but I think it’s going to have a bigger impact on the benchmarks.

It’s my opinion that the way CMS has been keeping score in the past understates the savings that have actually been achieved by the organizations. As evidence of that, the data that CMS provided us with the most recent proposed rule, the number of attributable beneficiaries by county along with their risk scores. And so when we took that data and compared the ACO performance against the country benchmarks excluding the ACO’s, there was a 3% difference between the 2 figures. Meaning that ACOs performed 3% better. I don’t believe that they were lower price coming into the program. In fact, the ACO program incentivizes high cost providers to go into the program because of the way the benchmarks were structured. So the actual savings may be somewhere well north of 3% when the CBO scores and other things have looked at it, it showed 1% or less.