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Government & Law

Texas Health Resources May Leave Pioneer ACO Program

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Texas Health Resources May Leave Pioneer ACO Program

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Plus ACO—the accountable care organization comprised of Texas Health Resources and North Texas Specialty Physician— has indicated to CMS that it intends to withdraw from the Pioneer ACO program within the next 30 days, THR announced Tuesday. Despite that announcement, the two entities have requested conversations with CMS about the possibility of remaining in the ACO program, if it can find an economically viable way to do so.

“We look forward to working with CMS in other areas, and we will continue to support the accountable care framework’s fundamental components—reducing costs, improving patient outcomes through enhanced quality of care and care coordination across the continuum,” THR spokesman Wendell Watson said in an email to D Healthcare Daily.

Watson said Plus ACO is on pace to save $10 million annually, yet is anticipating that it could be liable for a penalty between $6 million and $9 million at the end of the year. Currently, Pioneer ACOs have the option to drop out of the program with no penalty. Watson said the group will continue to work with commercial plans to implement accountable care programs.

An ACO is a collaboration of healthcare providers who accept the responsibility for the cost and coordination of its patients.  The financial incentive emphasizes quality, efficient care rather than quantity of care. If the ACO succeeds, its members receive a financial bonus. If it fails to meet its goals, the members may be penalized financially.

Eight other healthcare organizations have indicated their intent to opt out, according to Modern Healthcare: Primecare Medical Network, University of Michigan, Physician Health Partners, Seton Health Alliance, HealthCare Partners Nevada ACO, HealthCare Partners California ACO, JSA Care Partners, and Presbyterian Healthcare Services. CMS reported that costs for the nearly 670,000 Medicare beneficiaries cared for by Pioneer ACOs grew by only 0.3 percent in 2012, compared with an increase of 0.8 percent for those who did not take part in the Pioneer program.

“These results show that successful Pioneer ACOs have reduced costs for Medicare and improved the quality of care for their patients,” CMS Administrator Marilyn Tavenner said in a statement. “The Affordable Care Act has given us a wide range of tools to realign payment incentives in Medicare and Medicaid, and these efforts are already paying off.”