The Centers for Medicare and Medicaid Services (CMS) has been working to continually evolve and reform the Accountable Care Organizations (ACOs) program. A recent reform to the ACO program was the Pathways to Success Rule, which was enacted in late 2018, which focused on reforming the Medicare Shared Savings Program (MSSP). The Pathways to Success Rule aimed to address issues that ACOs experienced; one major issue was that some ACOs only reported savings and not losses. The new rule gives ACOs predictability and flexibility, leading to more dynamic payment reforms, cutting down on risks.
In February, the CMS conducted an analysis of the new rule on participation in the ACO program. Through the analysis, it was found that hospital-led ACOs and larger ACOs had lower droput rates in late 2018, compared to physician-led ACOs. Despite the new policy changes, smaller physician-led ACOs had the highest departure rate out of all ACOs.
In the analysis that the CMS released in 2019, a list of participating ACOs were also released. In the list, 74 ACOs had dropped out of the program by the end of 2018. Most of the ACO dro0pouts can be attributed to the new overhaul to the ACO program, but some had dropped out as their three year contract had ended (from its inception in 2015 to the end of 2018).
Looking closely at physician-led ACOs that had dropped out of the ACO program at the end of 2018, 42% of those ACOs had qualified as low revenue (according to the CMS’ definition). Out of those physician-led ACOs that had dropped out, smaller size physician-led ACOs had the highest exit rate, which is above 21%.
Read the original article from Health Affairs here.