Dart­mouth-Hitch­cock ends Pioneer par­tic­i­pa­tion

Modern Healthcare - - REGIONAL NEWS - —Me­lanie Evans

Dart­mouth-Hitch­cock Med­i­cal Cen­ter has pulled out of the Medi­care Pioneer ac­count­able care or­ga­ni­za­tion ini­tia­tive, which has lost nearly half of its 32 orig­i­nal par­tic­i­pants.

The Le­banon, N.H.-based cen­ter lost money dur­ing the Pioneer ACO ini­tia­tive, which re­quires par­tic­i­pat­ing providers to re­pay Medi­care for fail­ing to meet per­for­mance tar­gets on qual­ity and sav­ings. Dart­mouth-Hitch­cock CEO Dr. James We­in­stein said his sys­tem is at a dis­ad­van­tage un­der for­mu­las that cost the ACO $3.6 mil­lion in its third year.

Pioneer cost-sav­ing tar­gets re­ward im­prove­ment, mean­ing providers that are the least ef­fi­cient can make the great­est gains and earn the big­gest re­wards. But his sys­tem al­ready op­er­ated ef­fi­ciently. “You’re ask­ing or­ga­ni­za­tions that are al­ready run­ning re­ally well to run a two-minute mile,” he said. “It’s not pos­si­ble.”

To cre­ate in­cen­tives for ev­ery­one to im­prove, the CMS In­no­va­tion Cen­ter could min­i­mize po­ten­tial penal­ties for the most ef­fi­cient ACOs and limit the po­ten­tial bonuses for the least ef­fi­cient, he sug­gested. An­other is­sue, he said, is that qual­ity per­for­mance is not given the same weight as financial sav­ings.

Dart­mouth-Hitch­cock may en­ter Medi­care’s Next Gen­er­a­tion ACO pro­gram, a new test of the pay­ment model that will be­gin in Jan­uary. But We­in­stein said that model also has flaws.

Dart­mouth-Hitch­cock has dropped out

of the Pioneer ACO ini­tia­tive.

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