The CMS sought the panel's advice on the issue as it prepares to designate the next class of ACOs. The federal agency indicated that it's likely to issue new guidance before then that will reflect lessons learned from the first generation of ACOs.
“Our policy is built on a principle that we wanted to make entry into ACOs relatively easy,” said Scott Armstrong, MedPAC member and president and CEO of Group Health Cooperative, a Seattle-based not-for-profit health insurer. But, he added, “we want to start pushing more on this idea on being accountable for outcome of populations of patients.”
MedPAC's continued push for participants to take on more risk comes as nine of the 32 ACOs participating in the first year of the CMS Innovation Center's Pioneer program decided to switch to the Shared Savings Program or opt out of Medicare accountable care altogether because they struggled with the program's two-sided risk model.
Earlier this summer, the CMS indicated that only 13 of the Pioneer ACOs generated enough savings to share some of that money with the CMS. The Pioneers yielded gross savings of $87.6 million in 2012, saving about $33 million for Medicare.
While the consensus at the meeting was that Medicare ACOs should shoulder risk, Chairman Glenn Hackbarth and several other members said they would be open to a transitional model in which an ACO may start off with no risk and gradually assume risk, giving them a chance to invest and gain expertise in the model.
Follow Virgil Dickson on Twitter: @MHvdickson
