Recently, the Centers for Medicare & Medicaid Services (CMS) released its 2014 quality and financial performance results for Medicare Accountable Care Organizations (ACO). According to CMS, overall, 353 ACOs – 20 Pioneer ACOs and 333 Medicare Shared Savings ACOs – generated a net savings of more than $411 million in 2014. In addition, 97 ACOs met their quality standards and savings threshold, qualifying them for shared savings payments of more than $422 million. According to CMS Acting Administrator Andy Slavitt, “These results show that ac countable care organizations as a group are on the path towards transforming how care is provided. . . . Many of these ACOs are demonstrating that they can deliver a higher level of coordinated care that leads to healthier people and smarter spending.” According to CMS, some of the quality and financial performance results included:
- Of the 20 Pioneer ACOs participating in 2014, 15 ACOs generated savings and 5 ACOs generated losses. Of the 15 ACOs that generated savings, 11 ACOs qualified for shared payments of $82 million due to them generating savings outside a minimum savings rate. Of the 5 ACOs that generated losses, 3 ACOs are paying $9 million in shared losses to CMS for generating losses outside a minimum loss rate.
- Pioneer ACOs generated a total savings of $120 million, which equates to a 24% increase in performance from the $96 million of total savings in 2013. Further, the total model savings per ACO increased from $4.2 million per ACO in 2013 to $6 million per ACO in 2014.
- Of the 333 Medicare Shared Savings ACOs, 92 ACOs held spending below their targets, qualifying them for their share in the $341 million in program savings as performance payments. An additional 89 ACOs reduced health care costs in comparison to their benchmark, but did not meet the minimum savings threshold necessary to qualify for shared savings.
- ACOs that entered the Medicare Shared Savings Program in 2012 generated more shared savings than the ACOs that entered the program in 2013 and 2014 – 37% (2012) compared to 27% (2013) and 19% (2014).
Wachler & Associates will continue to stay up to date on all developments under Medicare’s ACO programs. If you or your health care entity has any questions regarding Medicare’s ACO programs, or any other health law questions, please contact an experienced healthcare attorney at (248) 544-0888, or via email at firstname.lastname@example.org. You may also subscribe to our health law blog by adding your email at the top right of this page.