The American Medical Group Association (AMGA) notified CMS that 93 percent of its members would not participate in the ACO demonstration project. Separately, on Thursday, ten of the nation's biggest multispecialty groups notified CMS administrator Don Berwick they will not take part in the ACO program. Concerns noted by both groups:
- Financial risk: downside risk for shared savings compounded by high investment costs required for ACO start-up and operation
- Severity adjustment for complex patients: limits on accounting for beneficiary acuity level dilutive to savings and potentially compromising proper patient management
- Excessive quality measurement requirements: too many quality measures in the first year (65 measures in five domains)
- Patient attribution: retrospective attribution will limit efforts to reduce costs
- Patient opt-out: an impractical opt-out system for Medicare beneficiaries
The same groups participated in the Physician Group Demonstration Project (circa 2005), considered the predecessor to the ACO. Only two were able to attain better than a two percent savings in the first year, and two were able to achieve the threshold after three years. Per CMS, the minimum savings threshold ranges from 3.9 percent for an ACO managing 5,000 Medicare fee-for-service (FFS) enrollees to two percent for an ACO with 60,000 enrollees.
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