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Health-law model drops out of Obamacare program

buck

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someone previously posted about how great the ACOs would be. Quite a few are dropping out and the results have been modest, at best.

Health-law model drops out of Obamacare program | The Seattle Times

Dartmouth faced mounting financial losses in a federal program that is in the vanguard of efforts to move Medicare away from a fee-for-service system.

In addition, he said, “There is little reason to think that ACOs will bend the cost curve in a meaningful way” unless they bear more financial risk, sharing losses as well as savings with the government.

“We were cutting costs and saving money and then paying a penalty on top of that,” said Dr. Robert Greene, an executive vice president of the Dartmouth-Hitchcock health system. “We would have loved to stay in the federal program, but it was just not sustainable.”

Since accountable-care organizations began operation in 2012, a number of them like Dartmouth have dropped out of the program, citing financial uncertainties and unrealistic benchmarks for spending.

Fisher said he was cautiously optimistic about the future of accountable-care organizations. “Evidence on spending suggests modest savings overall,” he said, though he acknowledged that in Medicare “the model has yet to achieve the benefits many advocates hoped for.”
 
Dartmouth-Hitchcock wasn't in a Medicare ACO program in 2016. What exactly are they dropping out of?

And even though they're not accepting Medicare incentives at present, I'm almost certain they're still an ACO and function as such in various commercial and Medicaid contracts.

Hmmmm....kinda wish you had defined "ACO."

It's a group of health care providers who agree to take on financial responsibility for delivering better results for their patients. Slow cost growth and improve quality performance and they get some of those savings back. In the more advanced models, if their costs go up faster than the rest of the country they have to give back some of the excess money they took in.

The point of it is that it gives those providers the latitude to try out new models for delivering care that are better for the patient but didn't make financial sense for the providers in the old world.
 
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Dartmouth-Hitchcock wasn't in a Medicare ACO program in 2016. What exactly are they dropping out of?

Seems you answered your own question. If they were in an ACO when the law took effect and are no longer in 2016.. what exactly did they drop out of?

The point of it is that it gives those providers the latitude to try out new models for delivering care that are better for the patient but didn't make financial sense for the providers in the old world.

Yeah, that is pretty much it.. this particular group met nearly every goal and led the benchmarks for their peers. While they reduced costs, they were a bit short on their savings goal. According to them, this is the reason they couldn't make the goal:

Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice, said: “It’s hard to achieve savings if, like Dartmouth, you are a low-cost provider to begin with. I helped design the model of accountable-care organizations. So it’s sad that we could not make it work here.”

Greene offered this analogy: It is easier for a person who runs a mile in 12 minutes to reduce the time to 10 minutes than for a 5-minute miler to break the 4-minute barrier.

Lastly, nearly half of the organizations have already dropped out of the program with similar complaints.
 
Seems you answered your own question. If they were in an ACO when the law took effect and are no longer in 2016.. what exactly did they drop out of?

For four years they were in the Pioneer program, a demonstration that ends in a few months. They decided a year ago not to take up the final option year of the program.

What's the news here?

Yeah, that is pretty much it.. this particular group met nearly every goal and led the benchmarks for their peers. While they reduced costs, they were a bit short on their savings goal. According to them, this is the reason they couldn't make the goal:

They didn't reduce costs after their first year. Their costs went up more quickly than the rest of the country which is why, unlike most of their peers, they had to pay money back. The problem this highlights isn't that providers experiencing higher cost growth than everyone else are on the hook for it (they ought to be!), it's that these programs are voluntary and a health system that isn't keeping pace can simply opt out of participation in future years.

You quoted Jha pointing out that provider systems have to bear downside risk and he's right! Not sure why you would quote that while simultaneously arguing we ought to go easier on systems experiencing higher spending growth.


Lastly, nearly half of the organizations have already dropped out of the program with similar complaints.

ACOs Over Time
Muhlestein_figure1.jpg


The model is expanding, not contracting.
 
For four years they were in the Pioneer program, a demonstration that ends in a few months. They decided a year ago not to take up the final option year of the program.

What's the news here?

Yah.. what would be the news in the medical center that created the ACO model.. not being able to be successful in that model and dropping out, despite savings.


They didn't reduce costs after their first year. Their costs went up more quickly than the rest of the country which is why, unlike most of their peers, they had to pay money back. The problem this highlights isn't that providers experiencing higher cost growth than everyone else are on the hook for it (they ought to be!), it's that these programs are voluntary and a health system that isn't keeping pace can simply opt out of participation in future years.

Someone didn't read the OP. They did reduce costs. From the article:

An evaluation for the federal government found that Dartmouth’s accountable-care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.

Again, according to them, it was because they were already so low, that they couldn't reduce the costs as much as other organizations that had much higher costs initially. It's easier to reduce high costs, then it is to reduce already low costs.

The model is expanding, not contracting.

I apologize. That was sloppy on my part. Of the 32 in the Pioneer ACO, Nearly half have dropped out. Dartmouth was going to sign up for the next Generation, but changed their mind and are not currently participating. It looks like it's well under half remaining, at this time.
 
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Sounds like a precursor to requiring all medicare participating providers to put their patients' medical records in a single database so that hospitals can access them to reduce the frequency of duplicate testing.
 
Shocking that there was no follow-up to note this week's news that Dartmouth-Hitchcock was one of the 28 health systems that joined the Next Gen ACO program in 2017.

You know, given how significant it was that out of the past five years of Medicare ACO programs they spent exactly one not participating! Is delivery system reform not doomed anymore?

 
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