Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, May 5, 2015

Pioneer ACOs save $384M in two years and meet criteria for expansion

By Bryant Storm, J.D.

Medicare’s Pioneer accountable care organization (ACO) model generated over $384 million in savings in the program’s first two years. The savings were achieved while maintaining high-quality patient care, according to an independent evaluation report released by HHS. As a result of the program’s success, the CMS independent Office of the Actuary has certified that the Pioneer model is the first to meet criteria for expansion to a larger number of Medicare beneficiaries.

ACA. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), authorized the creation of ACOs to incentivize the formation of entities, made up of multiple health care providers, who work together to coordinate care in order to keep costs down. The payment model is designed to shift the emphasis of the health care system from one that rewards doctors for quantity to own that rewards quality. ACOs “can share in savings generated for Medicare if they work to coordinate patient care, keep patients healthy and meet certain quality performance standards, or they may be required to pay a share of any losses generated.” The Pioneer ACO model allows experienced health care organizations to take advantage of the ACO initiative. Currently the Pioneer model serves over 600,000 Medicare beneficiaries

Results. The independent analysis of the Pioneer model revealed that Pioneer ACOs obtained $279.7 million in savings in the first performance year (2012) and $104.5 million in savings in the second performance year (2013). Although the overall performance was positive, the review discovered that there was significant variance in spending relative to the local markets for each of the 32 Pioneer ACOs. For example, ten Pioneer ACOs had statistically significant savings in both performance years, while 12 Pioneer ACOs had no statistically distinguishable savings or losses. In terms of quality, Pioneer ACOs showed statistically significant reductions in acute hospital admissions for certain conditions as well as increased rates of post-discharge physician follow-up. Additionally, beneficiaries aligned with Pioneer ACOs saw fewer acute inpatient stays and used fewer Part B services when compared to other beneficiaries in near markets. Patient satisfaction scores were found to be similar for Pioneer ACOs and non-ACO fee for service organizations.

JAMA. The analyses used in the report were also published in the Journal of the American Medical Association (JAMA). The JAMA article concluded that as one of several attempts to test the validity of the ACO model, the Pioneer initiative has been largely successful by reducing costs without having negative consequences on patient care experiences.

Companies: Journal of the American Medical Association

MainStory: TopStory HealthCareReformNews ReimbursementNews CMSNews HealthReformNews ACONews IPPSNews PartANews PartBNews OPPSNews QualityNews ProviderNews SafetyNews

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.

A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.