Healthcare industry leaders are pushing back against the Medicare Payment Advisory Commission's criticism of accountable care organizations. The panel is considering making changes that would force providers to take on more risk.
The group has said Medicare Shared Savings Program (MSSP) ACOs, which were introduced in the Affordable Care Act and encourage providers to coordinate patient care, aren't achieving the goals of lowering costs and improving quality of care.
There are 470 ACOs serving nearly 9 million beneficiaries. During its meeting earlier this month, MedPAC revealed that although the aggregate savings for for MSSP ACOs were $429 million, the program paid ACOs that had savings $646 million, resulting in a $216 million loss to Medicare.
The attempt at moving away from fee for service to value-based care allows physicians to share in any generated savings.
“Some ACOs do appear to save money, but Medicare could still lose money overall because it shares savings with the winners and does not collect from the losers,” David Glass, principal policy analyst at MedPAC recently said referring to the fact that most participating providers choose a risk arrangement that doesn't penalize those who fail to reach their goals.
“It feels like we're not making the progress that we would like, most certainly not the progress we tend to see more in the Medicare Advantage space,” Dr. Craig Samitt, a MedPAC commissioner and chief clinical officer at Anthem said at the meeting.
“If you'd have told me ten years ago or even seven years ago when we put out our first ACO report, that we would be in this situation right now, I would have been very disappointed,” added MedPAC Chairman Dr. Francis Crosson.
MedPAC Commissioner and former Congressman Bill Gradison said the panel should find ways to mandate participation in a two-sided risk model.
Melissa Myers, senior associate director of policy development at American Hospital Association said this was a bad idea since providers are still learning how to work within ACOs in the program's third year of existence.
“We need to be further along before casting doom on the model itself,” Myers said.
Carilion Clinic in Virginia has participated in an ACO since 2013 and didn't begin to achieve savings until 2015.
"We've seen other positive results and many providers believe this is the best plan for good patient care," said Donna Littlepage, Carilion Clinic's senior vice president for accountable care strategies.
Andrew Croshaw, president of Leavitt Partners Consulting agreed and said there is data to support that the longer an ACO operates the more success it has.
Industry leaders say it's irresponsible to have an influential panel such as MedPac speak negatively of ACOs because it could dissuade physicians from participating.
“We think that's a mistake,” said Travis Broome, healthcare policy lead at Aledade, a value-based care company that partners with independent practices on participating in alternative pay models.
They also argue that ACOs perform better than the data shows.
For instance, MSSP ACOs are only evaluated based on the care of Medicare beneficiaries that primarily receive their care from an ACO provider, versus those that may get care from a mix of ACO and other providers.
That means some aren't being counted, according to Jeffrey Spight, president of Collaborative Health Systems, a division of health insurer Universal American that operates about two dozen ACOs with Medicare shared-savings contracts.
ACOs are also being measured against benchmark savings goals that might not be accurately set by the CMS, said Allison Brennan, vice president of policy at the National Association of ACOs.
Earlier this year, the CMS acknowledged flaws in the benchmarking process. The agency has revised the way it calculates whether ACOs are saving money.
The CMS will adjust cost benchmarks based on regional rather than national spending data. The change is intended to measure participants' success against other providers in the same region rather than an ACO's own past performance.
Brennan says she expects this will affect performance results.