Criminal Law Library Blog
According to Medicare,” Accountable Care Organizations, or ACOs, are all about providing the best types of care for patients with Medicare, while simultaneously helping to lower the cost of healthcare. They consist of a coordinated group of doctors, hospitals and various types of medical providers who work together for the benefit of the patients they serve, allowing them to get the right care when they need it.” Additionally, their mission is to help control the amount of waste in the Medicare system. This includes patients seeing more than one specialist for the same condition and undergoing the same tests, as well as excessive visits. For additional information related to controlling waste and fraud in the Medicare system see my earlier posting Combating Fraud and Deception: Medicare’s Strategies and Initiatives .
On April 16, 2024, the Congressional Budget Office (CBO)* issued a report, Medicare Accountable Care Organizations: Past Performance and Future Directions, which summarizes recent research findings about Medicare accountable care organizations and the factors that have contributed to or limited their ability to achieve net budgetary savings for the Medicare program. The remainder of this posting includes a summary of this report prepared by the CBO and links to both the complete text of the report and to other publications related to it.
SUMMARY:
This Congressional Budget Office report summarizes recent research findings about Medicare accountable care organizations (ACOs) and the factors that have contributed to or limited their ability to achieve net budgetary savings for the Medicare program. ACOs are groups of providers, such as physicians and hospitals, that assume responsibility for the quality and cost of care for an assigned group of patients. Providers participate in Medicare ACO programs voluntarily. CBO found the following:
- Certain types of ACOs are associated with greater savings. They include ACOs led by independent physician groups, ACOs with a larger proportion of primary care providers (PCPs), and ACOs whose initial baseline spending was higher than the regional average. (An ACO’s baseline spending is generally the average spending per person in the Medicare fee-for-service, or FFS, program among beneficiaries that would have been assigned to the ACO over several calendar years before the start of the ACO’s contract period.)
- Some factors limit the savings from Medicare ACOs. Those factors include weak incentives for ACOs to reduce spending, a lack of the resources necessary for providers to participate in ACO models, and providers’ ability to selectively enter and exit the program on the basis of the financial benefits or losses they anticipate from participating.
Researchers and outside experts have suggested various policy approaches that could increase the savings that ACOs generate for the Medicare program. Those approaches include increasing providers’ incentives to participate in ACO models, increasing their incentives to reduce spending, and increasing beneficiaries’ awareness of and engagement with ACO models. The CBO has not assessed the effects of those policy approaches or determined their net budgetary impact.
RELATED PUBLICATIONS:
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October 18, 2023
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September 28, 2023
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*Established in 1974, The Congressional Budget Office (CBO) is a federal agency within the legislative branch of the United States government. It is charged with providing members of Congress objective analysis of budgeting and economic issues to support the congressional budget process. Each year, CBO economists and budget analysts produce dozens of reports and hundreds of cost estimates for proposed legislation.