AHA warns that Pioneer ACO program is in danger unless changes are made

Few additional providers will sign up to participate in Medicare’s current Pioneer ACO (accountable care organization) Model or the Medicare Shared Savings Program (MSSP) unless changes are made to the design of these programs notes the American Hospital Association (AHA) in a letter to the acting director of the Centers for Medicare and Medicaid Services (CMS) Innovation Center.

Linda E. Fishman, the AHA’s senior vice president of Public Policy Analysis and Development, writes that of the 32 participants that started with the Pioneer ACO program three years ago only 23 remain. She then predicts that efforts to attract additional participants will fail unless changes are made to tilt the risk vs. reward balance a bit more in providers’ favor.

Specific improvements Fishman outlines as needed if CMS wishes to get more providers to participate as a Pioneer ACO or in the MSSP include:

1. Getting participating providers more timely and accurate data on which Medicare beneficiaries are assigned to the ACO and their specific care utilization patterns.
2. Extend the Track 1 agreement period to six years to allow providers to fully implement changes and begin realizing results before they take on the risk of losing money if they fail to achieve savings.
3. Make the minimum savings rate no more than 2 percent for every one regardless of the number of attributed beneficiaries as it is a disincentive to hold smaller providers to a higher savings rate.
4. Make financial thresholds lower and more achievable in the early years, even it means raising them more later.
5. Make technical adjustments to benchmarks to account for policy changes beyond the provider’s control.
6. Allow beneficiaries to “opt in” to the ACO programs to make them more engaged and informed patients.
7. Allow beneficiary cost sharing to encourage beneficiaries to stay “in-network” within the ACO as it is a disincentive to hold providers responsible for coordinated care without any means for them to discourage patients from using providers outside of the ACO.
8. Simplify quality measures and align them with quality measures recorded by other programs to make reporting less burdensome.

However, the appetite for increasing spending on incentives for ACO program participation may be wanning. In February, the government's first release of data on the Pioneer ACO and MSSP revealed that only nine of the remaining 29 participating Pioneer ACOs achieved significant savings while also scoring high quality metrics. In addition, in the MSSP, less than half (54) of the 114 participating organizations have achieved savings and of those, just 29 saved enough money to receive “shared savings” bonuses.