Demonstration projects tally care improvements, cost savings
Jonathan Blum, deputy administrator and director for the Center of Medicare at the Centers for Medicare & Medicaid Services, says doctors are eager to try accountable care organizations (ACOs).
At a July 19 briefing in Indianapolis, Blum said he bases that opinion on the positive comments from doctors that CMS received on its proposed ACO rule, issued last March.
A study by the Healthcare Intelligence Network seems to support Blum’s opinion. It found that “a significant segment of the industry is reframing its care delivery structure as an ACO or will do so in the near future.”
The Aug. 10 report also found that of the 228 organizations surveyed, 95 percent of primary care physicians and 87 percent of specialists planned on participating in ACOs.
On Aug. 8, CMS reported the findings of its five-year pre-ACO demo. Only four of the 10 participating physician groups received incentive payments. CMS Administrator Donald Berwick, MD, recognized the difficulty in launching ACOs, while remaining positive. “We have learned to invest in sustained improvement over time,” he said, “and [learned] that short-term comparisons between start-up costs and measureable results may fail to realize the long-term value of these efforts.”
Marshfield Clinic, in Marshfield, Wisconsin was one of the top earners in the demo, according to CMS. Marshfield earned $56.2 million in bonus payments – more than half of the total payments in the demonstration project.
Tim Bartholow, a physician and senior vice president of the Wisconsin Medical Society, attributed Marshfield’s success to “earnestly caring about their population. They have the belief that, with or without this demonstration, their citizens deserve their best,” he said.
Bartholow is optimistic about ACOs, with the majority of physicians in Wisconsin already in some sort of ACO-type structure, he said. However, he called the results of the CMS demonstration sobering. “There were 10 highly motivated groups there. Only four were able to save resources and deliver higher quality care, and only two were able to sustain that.”
Despite the difficulty of building them, a lot is riding on ACOs, Bartholow said. Budgets are strained, Medicare and Medicaid are maxed out and America spends too much of its gross domestic product on healthcare.
“We’re capitated now as a country, but we don’t know it yet,” he said. “There isn’t a giant amount of extra cash that’s going to flow into our system.”
