Pioneer ACOs: Who will stay and who will go?

Thirty-two Pioneer ACOs sent a correspondence to CMMI in late February, suggesting that they would exit the Pioneer ACO program if CMS did not accept their recommendations for changes to the quality measures employed to determine pay for performance in the Pioneer program. As a group, the Pioneer ACOs suggested to CMMI that because of their collective experience with performance based contracts and performance reporting on quality measures, they — not CMMI — know what works and what doesn’t when it comes to benchmarking quality to reimbursment.

The Pioneer ACOs argued in their correspondence that the benchmarks set by CMMI were more rigorous than those typically adhered to in the commercial and Medicaid programs. They also argued that the data CMS was using for benchmarking was the Medicare Advantage data, which was not typical of a non-managed care population such as that attributed to the ACOs.

Bottom line: the Pioneers were asking to work with CMMI to come up with a different approach to benchmarking or they would leave the program.

CMS has responded by giving the Pioneer ACOs until May 1 to decide whether to stay or go. What is not clear: Whether CMMI/CMS is willing to compromise and modify the current approach to benchmarking and whether the Pioneer ACOs will leave the program en masse if their wishes are not met.

Note that the the non-Pioneer ACOs are also subject to the same performance based benchmarking approach.  So… will a Pioneer exit from the program result in a similar flight from the MSSP ACO program? If that were to occur CMMI/CMS would be faced with a public relations nightmare, one that I would think could be easily avoided by taking another look at the benchmarking issue.

Just saying!!

Resources

Read more on ACO opportunities in our white paper on the topic.

Read about how three Gorman Health Group clients were approved by CMS to become Operating Accountable Care Organizations.