Time is running out for several undecided Medicare Pioneer accountable care organizations to choose whether to stay or go.
The CMS recently announced that as many as nine provider organizations will make an early exit from the most ambitious federal test of accountable care, an experiment under the 2010 health reform law to overhaul payment to doctors and hospitals. The trial was launched in early 2012 as the Center for Medicare and Medicaid Innovation's Pioneer accountable care program, which sought to try out the payment model with hospitals and medical groups believed to be the most experienced and prepared for its financial risks.
Pioneers have until the end of July to decide. At least four of the 32 organizations have notified the CMS of tentative plans to switch out of the Pioneer program and join 250 other ACOs in Medicare's alternative test of the payment model, known as the Shared Savings Program. That model allows ACOs to opt for a payment arrangement that does not include the risk of financial losses.
The uncertainty of some Pioneer ACOs—just one year into the test to see if accountable care can deliver the quality gains and spending restraint hoped for by its proponents—raises questions about how successfully the largely untested payment model works in practice. ACOs are one of the key delivery system reforms established by the Patient Protection and Affordable Care Act, and thus are being closely watched. But experts said all along that the ambitious delivery-system changes envisioned in the ACO model would be difficult and take time to achieve.