HIGH-RISK PROCEDURE

CMS SELECTS FIRST ACO PARTICIPANTS IN MEDICARE SHARED-SAVINGS PROGRAM

Physicians take the lead in the next phase of Medicare accountable-care organization contracting program

Medicare is expanding and diversifying its experiment with accountable care. The latest crop of hospitals, medical groups and clinics that agreed to try out the payment model known as accountable care—the third group to date—was dominated by doctors without any formal ties to hospitals, some with as few as 30 to 50 physicians. That’s in contrast to early participants in different programs, announced late last year, which included prominent health systems and major medical groups such as Geisinger Health System and Monarch Healthcare.

Leaders at ACOS owned and operated solely by doctors said they nonetheless expect aid from hospitals in efforts to improve quality and curb costs thanks to existing relationships and pressure for hospitals to reduce avoidable readmissions.

“There were some people who feared that the only entities that would participate would be hospital-dominated systems,” Jonathan Blum, director of the Center for Medicare Management at the CMS, said in a call with reporters as the new accountable care groups were announced. “That has not happened.”

Also unique to the most recent slate of ACOS: one-third of them entered into joint ventures with a publicly traded insurance company.

With 27 accountable care organizations named last week, the total number of such networks under Medicare has grown to 65. The newly named ACOS include more than 10,000 physicians, 10 hospitals and 13 smaller physician-led entities.

Under accountable care, Medicare offers providers financial incentives—possible bonuses, and in some cases penalties—to improve quality and control costs for a select group of patients.

Fifty organizations applied to Medicare’s most accessible ACO effort, formally known as the Shared Savings Program. Three were denied as unprepared, Blum said in an interview. Twenty decided to withdraw and resubmit applications at a later date. Blum called it unsurprising that more organizations would apply for the later start date,

Dr. Alexander Perrian of New Pueblo Medicine hugs a patient. For the seven-doctor practice participating in a new Medicare ACO, bonus pay-for-performance measures from private insurers have helped offset investment costs.