Medicare's launch of accountable care has proved popular, attracting small and rural providers along with the large, well-funded medical groups and health systems considered best positioned to form ACOs.
The venture has mushroomed since January, to the satisfaction of federal officials who said the growth proved naysayers wrong.
The Syracuse ACO was one of 89 new ones named last week. “And I think, contrary to some fears that were expressed last year, we have a very strong program that exceeds our goals that we had for the first year,” Jonathan Blum, principal deputy administrator and director of the Center for Medicare, told reporters.
But it has come with some snags, including delays for data that providers deem crucial to success. Doctors and hospitals found other data unnecessarily cumbersome and lobbied the CMS for a fix.
And as hundreds more organizations are expected to apply for the next round of contracts, it's still too early to know whether the ones in the program are delivering better care at lower costs, as the government intends, and whether they will be compensated for their trouble.
“Everybody needs to be patient,” Page said, “the physicians, the patients and Medicare. This is a big experiment.” Doctors need time to change how they do their jobs. “I just hope that everybody's got the intestinal fortitude so that we can change at a pace that we can accommodate,” Page said, and that will require Medicare to set realistic goals and provide education.
“If they don't nurture us properly and allow us to mature at a rate we can mature at, then we'll fail,” he said.
Roughly six months ago, Medicare reached its first contracts for accountable care. Medicare agreed to give hospitals and doctors a cut if providers saved money on treating seniors and simultaneously hit quality targets.
Thirty-two organizations agreed to the deal in January under the CMS Innovation Center's Pioneer ACO model, joining a half dozen medical groups that first tested the payment model.
Since then, the number of Medicare accountable care contracts has increased four-fold. Another 27 organizations followed in April under the shared savings program created by the Patient Protection and Affordable Care Act.
The agency had significantly revised the final rules to make the program more attractive after sharp criticism of an early proposal. Last week, 89 ACOs became the latest to sign shared savings contracts—including the Syracuse ACO—and Blum said 400 more have expressed interest in contracts for next year. “We are building a program that is strong and is growing quickly,” he told reporters last week.
Medicare's latest accountable care contracts captured a cross section of the nation's healthcare operators, including some that rely on partners to clear away obstacles to entry.
Universal American, a publicly traded Medicare Advantage and supplemental insurance provider, owns a stake in one out of every 10 Medicare ACOs. That includes the Syracuse ACO and Essential Care Partners, an ACO composed of 14 federally qualified health centers across Texas.
Essential Care Partners would not yet be an ACO under contract with Medicare without its corporate partner's data analytics capabilities, said Jose Camacho, executive director of the Texas Association of Community Health Centers and board chairman of Essential Care Partners. “Not this quickly,” he said.
Universal American will receive a share of any savings bonus that doctors earn by holding down costs, said Robert Waegelein, co-president and chief financial officer for Universal American. The company expects to apply for the next round of Medicare ACOs. “We're very bullish on this opportunity,” he said.
Among the newest Medicare ACOs, one out of four are groups of fewer than 100 doctors and do not include a hospital in the formal network. One out of 10 ACOs has more than 1,000 doctors who have formally partnered with hospitals.
In an interview, Blum said there is no limit to the number of ACOs the agency can approve from each round of applications. “I am confident we have the resources in place to support the interest,” he said.
Support and feedback about what does and does not work will be necessary for ACOs to succeed, Page said. Now, the Syracuse ACO's doctors are waiting for data from the CMS. The medical group must also adapt its electronic health record to report new measures to Medicare, Page said. And doctors will need to talk with area hospitals not included in the ACO for help coordinating care as patients enter and exit the hospital.