Premier ACOs Posting Mediocre Results
Nearly a third of the health systems chosen for the ambitious Pioneer accountable care organization program with Medicare are leaving after the first year of the three-year program. The goal of accountable care is for hospitals and doctors to save money while lowering costs…
But only 13 of the Pioneers actually saved enough money to share those savings with Medicare, despite having invested in the programs and staff required to better coordinate care. And two Pioneers ended up owing the Medicare program $4 million. (Washington Post)
“According to data released by the Centers for Medicare and Medicaid Services today, all 32 Pioneers succeeded improving quality and performed better than fee-for-service Medicare in 15 quality measures. For the 669,000 Medicare beneficiaries in the Pioneer ACOs, spending grew by only 0.3 percent, compared to 0.8 percent in conventional Medicare.”
And this is only one year. I don’t think it is that big of a problem.
But there was also a selection bias:
“The systems selected to be Pioneers were the crème de la crème — hospitals that have already improved the way their care is delivered. “Most of the low hanging fruit is already gone in most cases,” he says, making it harder to further lower costs.”
That means a lot, sounds like this wouldn’t work on a large scale.
Interesting perspectives. Would be different without selection bias, most likely.
Good try, hopefully we can learn from this.
Unfortunately these schemes are fundamentally flawed by their reliance on a government/private partnership. The more convoluted the system becomes the less representative incentives actually are.
The article backs you up;
“‘Going forward, I think we should temper our expectations about how much money we’re as actually going to save through ACOs,’ says Roades. ACOs are basically a transitional ‘hybrid model’ that preserves the Medicare fee-for-service system and only applies to a portion of the patients that hospitals see. ‘It’s really hard to run two disparate sets of books at the same time’ and two sets of incentives, he adds.”
We may need more data for results and future predictions.
This is not surprising.
In other news, academics, activists, and politicians do a poor job of designing systems to replace the goods and services delivery systems developed by voluntary transactions between buyers and sellers.