The Centers for Medicare & Medicaid Services’ final rule for the Medicare Shared Savings Program released last month drew mixed reactions from the field. Graham Reeve praised CMS for taking steps to implement a more sustainable model and creating a broader range of available risk options.
What do you think about the latest set of rules regarding Medicare Shared Savings Program ACOs?
REEVE: We thought there were some positives in the rule:
• We liked the fact that if you were in the first agreement period, you can go into the second with [the same] one-sided risk track. We thought that was good.
• We also thought it was good that CMS did not reduce the 50/50 [risk-sharing] split to 60/40 for the second agreement period [as CMS proposed].
• We’re pleased with the new [more advanced] MSSP Track 3, which resembles the original Pioneer ACO model.
We would have liked to see them sunset the retrospective patient alignment and replace it with a prospective alignment [which would mean ACOs would know in advance who they’re covering]. We would have liked to have seen CMS incorporate a beneficiary care coordination reward program into all MSSP tracks as well.
How is your ACO coming along?
REEVE: It’s doing fairly well. We’re pleased with the first year of performance. We’re still learning as we go. During our first year, we saved nearly $4.7 million. We were pleased to see the reduction. We fell a little bit short of our minimum savings, so we didn’t experience any shared savings with CMS. But what we did in Year 1 was aggregate a lot of physicians. We have 450 physicians in our accountable care model. We made some progress and we’ll be set up better set up for Year 2 performance. Also, in the quality area, we saw quality improvement in each of the four domains: care coordination, preventive health, chronic disease management and patient satisfaction.
What have you learned about accountable care as a result of the ACO?
REEVE: We’ve learned a lot. Baptist itself has been pretty participatory in different models of care since 2008. We have been in bundled payment programs since early 2009. We have about 27,000 covered lives [in the ACO]. We’ve found that if you align incentives among providers, patients and physicians, everyone gets involved. We are going to continue to learn, to get better at this as we go forward, and that will benefit patients and decrease costs.