Yesterday, I reported that workers’ comp industry personnel believed that ACOs are a big driver of cost shifting under the Affordable Care Act. In that same article, I mentioned that anything that has a significant impact on healthcare, will also impact workers’ comp.
So, when I found an article on Modern Healthcare this afternoon that indicated that primary-care physicians are reaping the most from a CMS program under Medicare called the Shared Savings Program, I thought that this needed to be brought to light.
Today’s article seemed to contradict the impression the original article had on healthcare costs.
The article, by Melanie Evans, New York bureau chief for Modern Healthcare, stated that for the second year, CMS had awarded bonuses to 1 in 4 ACOs working under a Medicare model intended to spur providers to deliver lower-cost care.
These ACOs will share $422 million out of the $833 million they saved the government in 2014.
A review of disclosures by ACOs participating in the program found that primary-care doctors are benefiting the most.
The incentives that are paid directly to providers can be a powerful way to change the practice of medicine, Ms. Evans writes, as doctors alter their behavior to earn payouts.
Yet, research on the incentives has yielded mixed results.
Dr. Kavita Patel, managing director of clinical transformation at the Brookings Institution’s Center for Health Policy said, “We don’t have a good distribution model for ACO savings.”
Last week, the Obama Administration announced that 97 of the 353 ACOs earned bonuses in 2014, and most of them were in the Medicare Shared Savings Program.
Among the first cohort in the program, those that were specifically singled out as primary-care physicians, were equally likely to see no bonus as they were to earn payouts.
Participants said that they only distributed rewards to individuals after recovering expenses and investments. A few said they would hold some benefits in reserve in case of poor performance in the future, but most are reinvesting a percentage and dividing the rest among the physicians, specialists and hospitals.
One-third of participating ACOs said that they pass along a share of their award to primary physicians, as much as 80% in some cases. Those that disclosed detailed breakdowns of their allocations said 46% would go to primary physicians, on average.
Those who singled out specialists and hospital had lower percentages, 20% and 27%, respectively.
What does this mean?
If we are to believe that Medicare’s program for shared savings will lead to lower-cost care from primary physicians, then it is not likely that ACOs will lead to cost shifting, as the first article reported. And if what happens in healthcare impacts work comp, then this shared saving program should do the same if adopted by the workers’ comp industry.
Who is right, and who is wrong? I think neither article has been able to answer that question.
I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.
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