A 4 minute read
Doctors using computer whiles theirs colleagues looking at Xray in medical office
August 25, 2017

In the wake of provider criticisms, CMS has updated how physicians will be made aware of which patients will be monitored for the Medicare ACO program.

Medicare beneficiaries will now be allowed to list their primary care provider on the Medicare website. If the doctor is part of an ACO, the beneficiary will be assigned to that ACO next year. In the past providers have objected that most patients are retroactively assigned to ACOs, meaning that doctors aren’t notified which beneficiaries CMS will hold them most accountable for until the end of the performance year. Under the new protocol, providers will know at the beginning of the performance year which beneficiaries’ care they will be evaluated on.

The original protocol ensured that doctors couldn’t choose just their healthiest patients to participate in the ACO program. However, because providers didn’t know which patients were going to be evaluated at the end of the year, it was difficult to track the care of the chosen patients for themselves.

Top 10 ACO Hospitals by Net Patient Revenue

Hospital Net Patient Revenue (M) # Staffed Beds
New York Presbyterian Hospital - Weill Cornell Medical Center $4,935  2,037
Cleveland Clinic $4,688 1,268
NYU Langone Medical Center - Tisch Hospital $3,192  877
UCSF Medical Center at Parnassus Heights $2,935  782
Cedars-Sinai Medical Center $2,910 850
University Hospital - University of Michigan $2,866 914
Montefiore Medical Center Main Campus - Henry and Lucy Moses Hospital $2,690 1,453
Indiana University Health Methodist $2,595 1,259
Massachusetts General Hospital $2,578 987
Memorial Sloan Kettering Cancer Center $2,531 476

Fig 1 Data from Definitive Healthcare based on most recent CMS reports available.

In 2015, ACOs saved approximately $466 million for Medicare programs. Despite this, some providers are concerned about the amount of risk the ACO payment models require them to take. Not knowing which patients will be evaluated at the end of the performance year increases this apprehension.

Another change added by CMS this year is voluntary patient enrollment in an ACO. If beneficiaries list their primary care physician on the Medicare website, they will be automatically enrolled in that doctor’s ACO. It is still unclear, though, how many beneficiaries are declaring listing their providers on the site. This means that doctors may not know all of the patients in their ACO and will still be uncertain as to how CMS will evaluate them.

CMS hopes that voluntary ACO registration will increase patient awareness of the program and improve how they view it. However, if a beneficiary lists a provider that is not part of an ACO, they would be ineligible for assignment next year—even if the patient would have been assigned to one under current rules.

Top 10 ACOs by MSSP Expenditure

ACO Name Total MSSP Expenditures (M) State
Advocate Physician Partners Accountable Care $1,632 IL
Physician Organization of Michigan ACO $1,231 MI
Physicians Accountable Care Solutions $1,223 CT
Atlantic Accountable Care Organization $887 NJ
Iowa Health Accountable Care LC $823 IA
Delaware Valley ACO $795 PA
Mercy Health ACO $776 MO
UT Southwestern Accountable Care Network $756 TX
Palm Beach Accountable Care Organization $732 FL
Mercy Health Select ACO $696 OH

Fig 2 Data from Definitive Healthcare based on most recent CMS reports available.

If enough beneficiaries align with providers not participating in an ACO, industry professionals worry that the low volume of patients could cause providers to stop participating in the program as it would no longer benefit them.

Currently, 9 million beneficiaries are being cared for by approximately 480 Medicare shared-savings ACOs.

Read more about CMS payor mixes and programs like bundled payments on the Definitive Blog.

Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and other healthcare providers. Our database features detailed clinical information on hospitals and health systems, including procedure analytics, payments, and participation in CMS programs. Use our database to download a list of ACOs by type, region, payor, and more.

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