The mixed results for Medicare accountable care organizations continued last year with fewer than one-third of them qualifying for bonus payments, the CMS said Thursday.
The news comes as the administration is preparing providers for the new Medicare reimbursement program known as MACRA, which is set to begin collecting data in January. It shifts away from fee-for-service payments and toward value-based payments, thus promoting the use of programs like ACOs.
ACOs receive bonuses from shared savings based on formulas that account for performance and quality marks. The CMS recently announced that, starting next year, regional spending factors will also be incorporated. The administration has a goal of having 50% of traditional Medicare payments flowing through alternative payment models by 2018.
Dr. Patrick Conway, the CMS' chief medical officer, said in a conference call with reporters that he is pleased to see ACOs improving their performance as they gain more experience.
“There is significant improvement over time in terms of savings and also improvements in quality,” he said.
Dr. Nishant Anand, physician-in-chief at Memorial Hermann Health System, which has a shared-savings ACO, said the data shows important improvement.
“It basically confirms that the ACO model is capable of working,” he said.
It is the third year of data for Medicare's Pioneer ACOs and Shared Savings Program. In 2015, six of the 12 Pioneer ACOs received bonuses along with 119 of 392 Shared Savings Program ACOs. The Medicare ACO programs had a total savings of $466 million in 2015.
In 2014, CMS reported that 97 of 353 ACOs, or 28%, earned bonuses. Results from the programs' first year in 2013 were similar at 26%.
Four of the Pioneer ACOs generated losses, and one was penalized for exceeding the minimum loss rate. Two generated savings but did not reach the minimum for earning shared savings. Three of the Pioneer ACOs evaluated have since dropped out, leaving nine of the original 32 remaining.
Of the Shared Savings Program ACOs, 83 had costs lower than their benchmark but did not qualify for shared savings.
Quality measures showed some improvement from 2014 to 2015, especially in the Pioneer ACOs. Nine of the 12 Pioneer ACOs had quality scores of about 90%. The Shared Savings Program ACOs that reported in 2014 and 2015 improved on 84% of quality measures reported in both years.