Blog: A Pioneer turns 1

Doctors with the Beth Israel Deaconess Physician Organization (a group of 900 Harvard University faculty and an equal number of independent doctors) plowed into the second year as an accountable care Pioneer with a new hospital contract, but no performance results for the last six months.

“I kind of wish we knew,” said Dr. Stuart Rosenberg, president and chief executive of the Harvard Medical Faculty Practice, one of Medicare's first and most experimental accountable care organizations (hence the name Pioneers). Pioneers began roughly one year ago (see here for an interactive graphics on their location and vital stats) and hospitals and doctors face potential bonuses or losses based on quality and cost control performance.

Those results, despite federal officials' commitment and wishes, have been slow to come. “It's been a little bit flying in the dark this first year,” he said.

Interest in accountable care has grown among policymakers and the private market and its use in Medicare continues to expand. Medicare this week said it nearly doubled accountable care organizations in its shared savings program as of Jan. 1.

But the experimental payment model is largely unproven. One early test by 10 medical groups over five years failed to reduce spending, according to the Congressional Budget Office.

Jonathan Blum, the CMS acting principal deputy administrator and director for the center for Medicare, speaking to reporters this week said it would be too soon to publicly release results for Pioneers or any of the more than 100 other Medicare accountable care organizations launched last year.

(Rosenberg said doctors also receive dated data from a private insurance contract with incentives—potential for bonuses and losses—similar to accountable care, thought the lag is not so great, a one-month delay for data that is two months old.)

The lack of data does not appear to have dampened interest in the payment model.

Hospitals for the first time this year agreed to share in the financial risk of the doctors' new pay models, Rosenberg said. Hospitals share the risk for high cost hospitalized patients under the new arrangements. The new arrangement will receive $2 million annually each form hospitals and the physicians for investment under the newly created Beth Israel Deaconess Care Organization.

But a large majority of the financial incentives under the program will be paid to primary care doctors, not hospitals. “We think they have been underinvested in and underpaid” and they have value as care coordinators in accountable care, Rosenberg said.

But if primary care doctors succeed, fewer patients may be hospitalized and hospital revenue falls.

Hospitals may benefit another way, Rosenberg said, if the accountable care organization succeeds in attracting more of the market.



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