27 ACOs join Medicare shared savings program

The Centers for Medicare & Medicaid Services (CMS) announced April 10 that 27 accountable care organizations (ACOs) will participate in CMS’ Medicare Shared Savings Program. Through the program physicians and hospitals will work together to coordinate and improve care for seniors and share in the subsequent savings from delivering that care.

The 27 Medicare Shared Savings Program ACOs will serve an estimated 375,000 beneficiaries in 18 states, including New York, North Carolina, Mississippi and Texas, according to the CMS announcement.

That brings the total number of organizations participating in the Medicare shared savings initiatives as of April 1 to 65, including the 32 Pioneer Model ACOs that were announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011.

As of April 1, more than 1.1 million Medicare beneficiaries are receiving care from providers participating in these initiatives, CMS reported.

Individuals treated by multiple doctors sometimes experience the manifestations of disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.

ACOs are designed to lift this burden from patients, while enhancing the quality of care and reducing costs, said Marilyn Tavenner, CMS acting administrator.

The Affordable Care Act called for the creation of the Shared Savings Program after a number of efforts in the private sector showed that improving care can lead to lower costs.

The selected ACOs include more than 10,000 physicians, 10 hospitals and 13 smaller physician-driven organizations in both urban and rural areas. Their models for coordinating care and improving quality vary in response to the needs of the beneficiaries in the areas they are serving, CMS said.

The agency is reviewing more than 150 applications from ACOs seeking to enter the program in July.

“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” Tavenner said.

Participation in an ACO is voluntary for providers and Medicare beneficiaries, who may retain their current ability to seek treatment from any provider they wish.

To ensure that savings are achieved through better care that is appropriate, safe and timely, an ACO must meet strict quality standards.

For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and the patient and caregiver experience of care.

CMS also announced that five ACOs are participating in the Advance Payment ACO Model beginning April 1. This model will provide advance payment of expected shared savings to rural and physician-based ACOs participating in the Shared Savings Program that would benefit from additional start-up resources. These resources will help build the necessary care coordination infrastructure necessary to improve patient outcomes and reduce costs, such as new staff or health IT systems.

CMS is reviewing more than 50 applications for Advance Payments that start in July.