The Centers for Medicare & Medicaid Services (CMS) has announced 121 new Medicare Accountable Care Organization (ACO) participants. Spokesman Brian Reardon said more than 21,000 patients will be part of the Hospital Sisters Health System accountable care organization, or ACO. By 2018, HHS wants half of Medicare payments to flow through ACOs and other programs that take into account whether beneficiaries are receiving quality care. Participating hospital CFOs are queried monthly on the financial status of their organizations, and none have reported negative effects of being associated with accountable care, while most have described increased revenue and improved staff satisfaction.
“The new model offers a new opportunity in accountable care – one that enables providers and beneficiaries greater opportunities to coordinate care and aims to attain the highest quality standards of care”, CMS stated. As part of the Next Generation mode, the participating ACOs already have significant experience coordinating care through other initiatives, such as MSSP and the Pioneer model.
View an overview of the new NGACO model here. HSHS ACO L.L.C. will be one of 434 ACOs participating in the Shared Savings Program as of January 1, 2016. ACOs were created to change the incentives for how medical care is paid for in the USA, moving away from a system that rewards the quantity of services to one that rewards the quality of health outcomes.
Next Generation includes six hospitals that have moved up from the Pioneer program: Beacon Health in Maine; Bellin-ThedaCare Healthcare Partners in Wisconsin; OSF Healthcare in Illinois; Park Nicollet Health Services in Minnesota; Steward Healthcare Network in MA; and Trinity Health ACO in Iowa. Although many organizations have been hesitant to implement a value-based care model, Barasch said the success the group has had indicates it is possible, although he warned results won’t show up immediately. The government said this would provide a long-term incentive for beneficiaries to get their care in the ACO network.
Six health systems switched from Pioneer to Next Generation status, meaning the Pioneer program now has been whittled down to only nine participants, after a rash of drop-outs.
When the Next Generation model was announced early past year, observers questioned whether hospitals and physicians would have enough control over patients’ utilization patterns and tendencies to roam outside the ACO network, undermining quality and cost-control efforts. Medical office staff will be trained in population health management, including care coordination, quality improvement, annual wellness visits, and patient satisfaction, and can begin billing for these professional services.
The Health and Human Services secretary, Sylvia Mathews Burwell, has set a goal of tying 30 percent of Medicare payments to programs like ACOs by the end of this year. This group includes 55 rural PPS hospitals, 92 Critical Access Hospitals, 168 Rural Health Clinics, and 39 rural FQHCs serving more than 500,000 Medicare patients. If beneficiaries committed to seek care through their ACO, the ACO could pay them $50 every year, fully funded by the CMS.