It’s no fun being a curmudgeon these days because there is so much to work with, but reality always fascinated me. I used to be good at communicating good news too; it’s all in the presentation. At the risk of incurring the wrath of my liberal acquaintances, allow me to take a closer look at this good news.
First, read the details about these savings and see if you can figure out what the facts really are. There is a link below so don’t take my view alone.
Then do some simple math. CMS says these savings are for a two year period and that there are 5,600,000 Medicare beneficiaries assigned to a Accountable Care Organization (whether they know it or not). So let’s do the math; 472,000,000/5,600,000 = $84.29/2 (years) = $42.15 in savings per year; less than the cost of one office visit.
What is not clear and not mentioned in the Fact Sheet from CMS is if these savings are net of all administrative costs. Given there is no such claim I suspect they are not.
We also read about improvement in quality measures:
Shared Savings Program ACOs improved on 30 of 33 quality measures. Quality improvement was shown in such measures as patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctor, health promotion and education, screening for tobacco use and cessation, and screening for high blood pressure.
If these are the highlighted measures, it’s pretty weak stuff. Quality in health care has more to do with receiving the appropriate level of care, the appropriate amount of care in the right setting with as good or better outcomes compared with valid benchmarks.
Frankly, I hope the ACO experiment and all the other programs within Obamacare are successful. However, I fought the health care cost war for four decades and tried every new idea that came along so I am skeptical, even more so knowing the favorable spin generated by government and much of the press, especially by this Administration on this topic.
CMS Press Release
New Affordable Care Act tools and payment models deliver $372 million in savings, improve care
Pioneer ACO Model and Medicare Shared Savings Program ACOs part of plan to improve care and lower health costs across the health system
The Centers for Medicare & Medicaid Services (CMS) today issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have improved patient care and produced hundreds of millions of dollars in savings for the program.
In addition to providing more Americans with access to quality, affordable health care, the Affordable Care Act encourages doctors, hospitals and other health care providers to work together to better coordinate care and keep people healthy rather than treat them when they are sick, which also helps to reduce health care costs. ACOs are one example of the innovative ways to improve care and reduce costs. In an ACO, providers who join these groups become eligible to share savings with Medicare when they deliver that care more efficiently.
ACOs in the Pioneer ACO Model and Medicare Shared Savings Program (Shared Savings Program) generated over $372 million in total program savings for Medicare ACOs. The encouraging news comes from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs, and final results from the first year of performance for 220 Shared Savings Program ACOs.
Meanwhile, the ACOs outperformed published benchmarks for quality and patient experience last year and improved significantly on almost all measures of quality and patient experience this year. (Please see the accompanying fact sheet for additional details.)
QUINNSCOMMENTARY 