Shouldn’t CMS Officials Be More Straightforward About ACOs’ Level of Progress? Sorting through the Jumble of Numbers for Clarity | Mark Hagland | Healthcare Blogs Skip to content Skip to navigation

Shouldn’t CMS Officials Be More Straightforward About ACOs’ Level of Progress? Sorting through the Jumble of Numbers for Clarity

August 27, 2016
| Reprints
CMS officials’ presentation of the latest ACO statistics lacked clarity and transparency

As HCI Managing Editor Rajiv Leventhal noted in his news article on Thursday, senior officials at the federal Centers for Medicare & Medicaid Services (CMS) yesterday lauded the progress of accountable care organizations (ACOs) participating in both the Medicare Shared Savings Program (MSSP) for ACOs and the Pioneer ACO program.

The announcement itself began thus: “The Centers for Medicare & Medicaid Services (CMS) today released the 2015 quality and financial performance results for Medicare Accountable Care Organizations (ACOs) that show that ACOs continue to improve the quality of care for Medicare beneficiaries, while generating financial savings. As the number of Medicare beneficiaries served by ACOs continues to grow, these results suggest that ACOs are delivering higher quality care to more and more Medicare beneficiaries each year. According to the results,” the CMS announcement stated, “over 400 Medicare ACOs generated more than $466 million in total program savings in 2015, accounting for all ACOs’ experiences. Of these, 125 qualified for shared savings payments by meeting quality performance standards and their savings threshold. The results show that more ACOs are sharing savings in 2015 compared to 2014 and that ACOs with more experience in the Pioneer ACO Model and the Medicare Shared Savings Program tend to perform better over time.”

But, as Leventhal pointed out in his article, after doing some analysis of the statistics, the reality is that “Although more than 400 Medicare accountable care organizations (ACOs) generated more than $466 million in total program savings in 2015, nearly seven in 10 of those ACO organizations did not generate enough savings to receive bonuses, according to an Aug. 25 announcement from the Centers for Medicare & Medicaid Services (CMS).

As Leventhal noted, “According to the just-released CMS data, 125 of the 404 total federal ACOs qualified for shared savings payments by meeting quality performance standards and their savings threshold. The results show that more ACOs are sharing savings in 2015 compared to 2014 and that ACOs with more experience in the Pioneer ACO Model and the Medicare Shared Savings Program (MSSP) tend to perform better over time. However, similar to last year, many of these ACOs did not produce enough savings to earn bonuses.”

Meanwhile, he also noted, of the 12 remaining ACOs in the Pioneer ACO program, which began with 32 ACOs in 2012, and is down to 12 now, eight of the ACOs generated savings last year, six of them generating enough savings to earn shared savings back to their organizations; meanwhile, only one of the four ACOs in the program had to pay money back to the Medicare program. Not a super-great set of outcomes, but not a bad set of outcomes, either.

So what are the top-line financial and clinical outcomes measures from both programs? With regard to financial savings, 119 of the 392 MSSP ACOs, or 30 percent, generated shared savings, while six of the 12 Pioneer ACOs, or 50 percent, generated shared savings. And, as CMS officials reported in their announcement, “83 ACOs had health care costs lower than their benchmark, but did not qualify for shared savings, as they did not meet the minimum savings” requirements. Meanwhile, “An increasing proportion of ACOs have generated savings above their minimum savings rate each year. For PY15, 31 percent of ACOs (120 of 392) generated savings above their MSR compared to 28 percent (92 of 333) in PY14 and 26 percent (58 of 220) in PY13.” And, CMS officials noted, “ACOs with more experience in the program were more likely to generate savings above their MSR [minimum savings requirement]. For performance year 2015, 42 percent of ACOs that started in 2012 generated savings above their MSR, compared to 37 percent of 2013 starters, 22 percent of 2014 starters and 21 percent of 2015 starters.”

Meanwhile, when it comes to quality outcomes, CMS officials noted Thursday that “Shared Savings Program ACOs that reported quality in both 2014 and 2015 improved on 84 percent of the quality measures that were reported in both years. The average quality performance improved by over 15 percent between 2014 and 2015 for four measures: screening for risk of future falls, depression screening and follow-up, blood pressure screening and follow-up, and providing pneumonia vaccinations.” Further, they added, “Over 91 percent of ACOs in a second or third performance year during 2015 increased their overall quality performance score through Quality Improvement Reward points in at least one of four quality measure domains.”

As for quality outcomes among the Pioneer ACOs, CMS officials noted that the mean quality score among Pioneer ACOs increased to 92.26 percent in the fourth year from 87.2 percent in the third year. The mean quality score has increased in every year of the model, with a total increase of over 21 percentage points since the first year. Of the 12 Pioneer ACOs, nine had overall quality scores above 90 percent for the fourth year, with scores ranging from 92.59 percent to 98.38 percent. What’s more, quality performance improved considerably from 2014 to 2015 and across all four years of the Pioneer ACO Model. Overall quality scores for nine of the 12 Pioneer ACOs were above 90 percent in the fourth year. All 12 Pioneers improved their quality scores from 2012 to 2015 by over 21 percentage points, according to the CMS data.

What does it all mean?

Pages

Topics