The CMS' Pioneer accountable care organizations are reducing the number of services they provide to patients that have minimal clinical benefit, a study in JAMA Internal Medicine found.
The results suggest that the ACO program is having its intended effect. By changing the incentives for how healthcare services are reimbursed, the CMS is pushing providers to change the way they practice medicine.
The Pioneer program is the riskier of the CMS' two ACO initiatives because healthcare providers are on the hook for financial losses if they fail to reduce the cost of care. The program also sets quality benchmarks that providers must meet.
“Although adjusting practice to lower costs is a stretch from physicians' traditional role, the well-being of their patients and their communities now depend on it,” wrote Dr. Arnold Milstein, director of Stanford University's Clinical Excellence Research Center, in an accompanying editorial.
Researchers at Harvard Medical School looked at 31 healthcare services that were deemed of little clinical benefit, such as certain cancer screenings and certain preoperative, imaging and cardiovascular tests.
They measured service count and spending per 100 Medicare beneficiaries before the Pioneer program began, from 2009 to 2011, and in the first year of the program, which started in 2012.
Pioneer ACOs in their first year performed 1.9% fewer low-value services, or 0.8 fewer services per 100 beneficiaries. They also reduced spending on those services by 4.5%.
Those organizations that had been performing the largest number of low-value services prior to 2012 saw the largest reduction, or a decline of 1.2 services per 100 beneficiaries.
“Despite the limitations of the study, our findings … are consistent with the conclusion that the overall value of healthcare provided by Pioneer ACOs improved after their participation in an alternative payment model,” the authors wrote.
The study comes about a month after the CMS released results for the 2014 program year and concluded that ACOs tend to perform better over time.
A total of 55% of the 20 participating ACOs managed to reduce costs enough to receive bonus payments for shared savings in 2014. Across the program, the total savings was $120 million, a 24% increase over the prior year.
However, five ACOs produced no savings, and three generated losses above the minimum loss rate, which meant they shared in the losses with the CMS.
The high standard for achieving savings has whittled the original group of 32 Pioneer ACOs to its current 19 this year.
