CMS Report: Fewer Than One-Third of ACOs Qualified for Medicare Bonuses

ACO association expresses disappointment

According to a new report from the Centers for Medicare and Medicaid Services (CMS), only 27% (125 of 470) of accountable care organizations (ACOs) qualified for bonuses from Medicare in 2015. The CMS makes payments to ACOs that meet the agency’s quality performance standards and savings threshold.

The CMS also reported that only 31% of ACOs generated savings of $466 million.

ACOs are judged on their performance, as well as their improvement, on metrics that assess the care they deliver. Those metrics include how highly patients rated their doctor, how well clinicians communicated, whether patients were screened for hypertension, and the use of electronic health records.

The National Association of ACOs “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” the group’s CEO, Clif Gaus, told FierceHealthcare via email, adding: “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”

Gaus also said that the CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program.”

According to the CMS report, ACOs participating during the past two years improved on 84% of the quality performance measures used. In addition, average quality performance increased by 15% on key preventive-care measures for falls, depression, blood pressure screenings, and follow-ups.

ACOs were created to change the incentives for how medical care is delivered and paid for in the United States, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes, according to the CMS. ACOs are groups of doctors, hospitals, and other health care providers who voluntarily come together to develop and execute a plan for a patient’s care and share information, putting the patient at the center of the health care delivery system. In addition, under the proposed quality payment program, health care providers that sufficiently participate in advanced tracks of Medicare ACOs may qualify for exemption from payment adjustments under the merit-based incentive payment system, as well as for the additional incentive payments available beginning in 2019 for participation in advanced alternative payment models.

A new “final rule” instituted by the CMS in June factors the ability of ACOs to deliver quality care at lower cost compared with local competitors into ACOs’ reimbursement. The rule change ended the previous practice of reimbursing ACOs based on past performance evaluations, FierceHealthcare reported.

Sources: CMS; August 25, 2016; and FierceHealthcare; August 26, 2016.