Plus ACO Asks Medicare to Reconsider Benchmarks

Plus ACO, an accountable care organization (ACO) partnership between Texas Health Resources (THR) and Fort Worth-based North Texas Specialty Physicians (NTSP), is one of 18 Medicare Pioneer ACOs that are asking Medicare to reconsider the benchmarks it has set for the program.

In a letter to the Centers for Medicare and Medicaid Innovation (CMMI), the ACOs say there is too little data behind the measures used for incentives and do not take into account the hospitals’ baseline data. The ACOs were selected for the Pioneer program based on their experience with accountable care and for track records of healthcare quality.

In 2012, the Pioneer ACOs received payments for reporting data. In 2013, the providers are expected to transition to pay-for-performance.

The hospitals said 19 of the 31 measures upon which they will be judged have “flat percentage benchmarks without anchoring methodology. This reflects the lack of data surrounding these measures.”

They said the proposed benchmarks exceed those of commercial contracts and for Medicaid. They asked that 2013 be another year for collecting data and that they help CMMI improve its methodology.

“We recommend CMS and Pioneers collaborate to develop quality benchmark methodology, in

particular in response to the flat percentage approach. As Pioneers, we have extensive experience with performance based contracts and quality performance reporting; our hope is that CMS and CMMI will leverage that experience to vet benchmarking methodology,” the letter said.

The hospitals are asking CMMI to respond to their recommendations by April 2.

Asked to elaborate on the letter, THR chief operating officer Barclay Berdan issued the following statement: “The intent of the Pioneer ACO program is to learn what works in an ACO setting and how to improve quality, outcomes and operational areas. We have an ongoing dialog with CMS through which we exchange information and ideas.”

Medicare has been criticized for its quality-rating program in the Medicare Advantage program, which assigns one-to-five stars. The plans with higher star ratings receive bonus payments. According to the Government Accountability Office, about 90 percent of the plans qualified for bonuses.

There is precedence for Medicare reconsidering pay-for-performance formulas. The program has changed its hospital readmission penalty calculations twice in the past six months.

Plus ACO has 19,000 patients who will be enrolled in the traditional Medicare plan. NTSP, which serves patients in Tarrant, Parker, and Johnson counties, has more than 10 years of experience in population health management and has participated in quality initiatives tied to financial incentives. It cares for about 30,000 Medicare Advantage patients—including 25,000 in United Healthcare’s Secure Horizons plan and about 5,000 in its wholly owned Care N’ Care plan. Plus ACO will have 19,000 patients who will be enrolled in the traditional Medicare plan.

The physicians’ group has more than 600 physicians, a quarter of whom are primary-care physicians.

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

 

 

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