In its drive to reduce Medicare spending, the federal government is trying to increase participation in accountable care organizations by aligning patients with a particular ACO if their primary care doctor is part of one.

The change comes in response to complaints from doctors about the current system, in which the administration assigns a certain number of a doctor’s patients to the ACO retroactively, meaning the ACO is not being judged based on all of the patients it treats. That system, say officials, was aimed at preventing doctors from cherry-picking the healthiest patients to participate in the program.

Under the new system, doctors will know from the beginning which patients’ treatment will be assessed as part of the Medicare Shared Savings program, in which roughly 480 ACOs are currently participating on a voluntary basis.

One potential problem, physicians have argued, is that for patients to be enrolled in the ACO, they have to go to a website, MyMedicare.gov, to enter their primary care doctor. Some Medicare patients, many of whom don’t have access to computers or are uncomfortable using them, might not do so.

Officials estimate roughly 30 percent of Medicare beneficiaries are already using the website, according to Modern Healthcare.

Ever since the advent of Medicare ACOs as part of the Affordable Care Act, federal officials have gone back and forth with providers about how to fairly design a system which rewards and incentivizes efficient, quality care.

The first program, the Pioneer ACO Model, attracted 32 ACOs when it kicked off in 2012 but only had eight left when it ended in December. Many providers dropped out of the program, saying the risk they were assuming with the performance-based pay outweighed the potential rewards.

Four ACOs have dropped out of the Next Generation program, which began in January 2016, but others have since joined. The program now touts 45 ACOs.

Both the Pioneer initiative and the Next Generation program are aimed at ACOs with more experienced ACOs that are willing to submit to a greater potential for shared savings and penalties based on performance. The great majority of ACOs remain in the MSSP.

Instant Insights /

Feds unveil new enrollment system for Medicare ACOs

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