Three of the 11 Texas-based accountable care organizations that earned shared savings payments from Medicare’s value-based payment program are headquartered in North Texas and saved the government more than $50 million.
The data, released Thursday by the Centers for Medicare and Medicaid Services, detailed the success—or lack thereof—of the nation’s 392 Medicare Shared Savings-approved ACOs, which netted the program $429 million. In Texas, the ACOs that earned rewards helped save $222 million. But after the other 15 participants were considered, eight of which lost money, the net from the Lone Star State came out to about $200 million.
UT Southwestern Medical Center’s ACO was the state’s No. 2 savings generator, notching $29.9 million for the government over its 67,672 beneficiaries. Its physicians got back $14.2 million in incentive payments. Methodist Health System’s Alliance for Patients and Physicians ACO recorded $18.7 million in savings and was awarded $8.3 million in incentive payments. It enrolled 14,229 patients. The Accountable Care Coalition of North Texas also earned shared savings payments across its population of 5,698, saving the government $4.7 million and getting back $2.2 million. And the Carrollton-based Premier Patient Healthcare ACO saved more than $12 million and received $5.8 million in incentive payments. Unlike the others, Premier extends into southern Oklahoma as well.
The Genesis Accountable Physician Network, operated by the independent doctor IPA the Genesis Physician’s Group, saved Medicare $1.9 million through its 12,700 beneficiaries, but it wasn’t enough to hit the ratio to receive incentive payments. In its first year in the Shared Savings program, the Baylor Scott & White Quality Alliance lost about $4.8 million across its 64,308 beneficiaries. USMD Physician Services fared worst, falling $8 million below benchmark on 21,597 beneficiaries.
Medicare’s Shared Savings program weighs an ACO’s total expenditures against what it deems to be benchmark expenditures related to its patient population. If the total expenditures are below the benchmark, then the ACO saved Medicare money. Hit a defined ratio, and the organization will receive incentives—hence the shared savings. CMS says 119 nationwide qualified for the rewards and another 83 notched healthcare costs lower than their benchmark, but didn’t hit the minimum savings required for the reward payments.
This is the most successful year yet for the program, which was born out of a provision in the Affordable Care Act. In 2015, 31 percent of the ACOs generated savings, up from 28 percent in 2014 and 26 percent in 2013. Also, the longer they’re in it, the better the chances of savings. About 42 percent that joined the program in 2012 hit above the benchmark. Of those that launched in 2013, 37 percent achieved savings. Twenty-two percent of starters from 2014 saved money and 21 percent of the 2015 beginners did so. Which is to say, Baylor Scott & White’s first-year result is fairly common.
The highest-performing Shared Savings ACO in the country is Houston’s Memorial Hermann Accountable Care Organization, which saved almost $90 million and received roughly $42 million in incentive payments. UT Southwestern ranked No. 8 and Methodist’s came in at No. 13.
Details regarding the ACOs that received incentive payments:
1. UT Southwestern Accountable Care Network — $14,188,861 in shared savings, $29,968,600 in generated savings / 67,672 beneficiaries, 96.66 percent quality score
2. Methodist Alliance for Patients and Physicians – $8,328,054 in shared savings, $18,718,445 in generated savings / 14,229 beneficiaries, 90.8 percent quality score
3. Premier Patient Healthcare – $5,835,335 in shared savings, $12,724,363 in generated savings / 21,928 beneficiaries, 93.59 percent quality score (Present in Texas and Oklahoma)
4. Accountable Care Coalition of North Texas, LLC – $2,181,324 in shared savings, $4,707,990 in generated savings / 5,698 beneficiaries, 94.56 percent quality score
Genesis, which saved money but not enough to receive payments:
5. Genesis Accountable Physician Network – $133,893,005 in benchmark expenditures / $131,961,704 in total expenditures, $1,931,301 savings / 12,700 beneficiaries, 95.12 percent quality score
And the two that didn’t meet their benchmarks:
6. Baylor Scott & White Quality Alliance – $557,042,141 in benchmark expenditures / $561,885,734 in total expenditures, -$4,843,593 difference / 64,308 beneficiaries, P4R rating (notes that it’s a first year contract)
7. USMD Physician Services – $180,966,072 in benchmark expenditures, $188,990,375 in total expenditures, -8,024,303 difference / 21,597 beneficiaries, 96.33 percent quality score