Health Care Law Blog

Pioneer ACOs Find Blazing New Trails Isn't Always Easy

According to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013.

While this may look dubious, the Pioneer program has much more risk than the Medicare shared savings program. Specifically, all Pioneer ACOs risk financial loss based on performance after their second year of participation (the program began last January). The Medicare shared savings program offers an option with no potential for financial penalties for the first three years. 

Additionally, the Medicare shared savings program may reflect lessons learned by the Pioneer ACOs in the Pioneer program. For instance, part of the reason that the Pioneer ACOs may be leaving the program is that the Pioneer program does not lock patients into an ACO's provider network, yet the ACO is still responsible for quality and costs of the patient's care. Others have also stated that Pioneer ACOs face challenges regarding the electronic health records systems utilized.  Specifically, some report having issues related to lack of IT inoperability; problems in obtaining functionality needed for meaningful use; and difficulties with varying connection speeds. 

While opponents of ACOs may look to this development as evidence of the breakdown of the ACO system, the first participants will always face risks and obstacles. ACOs appear to the be future of health care, and the Pioneer program will undoubtedly provide valuable information related to the ongoing viability of ACOs.

For more information about how ACOs may affect your practice, contact Nicole Stratton at (517) 371-8140 or by using the form below.

Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians