Seven ACOs drop out of Next Generation program but don't say why
The at-risk model has grown, but for some accountable care organizations obtaining financial benchmarks remains elusive.
Seven accountable care organizations have left Next Generation, Medicare's highest-risk program that qualifies as an advanced alternative payment model under MACRA.
In January, the Centers for Medicare and Medicaid Services announced 58 ACOs had joined Next Gen for 2018, an increase from the estimated 28 that took part during the first year in 2016 and up from 45 participants in 2017.
[Also: CMS announces 45 ACOs are now participating in Next Generation model]
The 58 included 14 new and 44 returning organizations. Of those, 51 remain.
The health systems that have left include the The Accountable Care Coalition of Chesapeake, Allina Integrated Medical Network, Fairview Health Services, KentuckyOne Health, LifePrint, MemorialCare, and Sharp Healthcare, according to a tweet by David Muhlestein, chief researcher for Leavitt Partners, who could not immediately be reached for comment.
[Also: CMS announces 58 ACOs participating in Next Generation]
"CMS understands that each organization makes its decision to participate in the Next Generation ACO Model based on its particular business priorities and concerns," a CMS spokesperson said. "Organizations consider their projected financial risk in the context of their particular circumstances."
In past years, health systems have left Next Generation saying the metrics were too high a standard to reach the savings needed to earn payments.
The Next Generation model rewards hospitals that assume higher levels of financial risk more than other models, such as the Medicare Shared Savings Program. But it also penalizes those that fail to reach targeted benchmarks.
Its benefit enhancements waive certain Medicare rules for telehealth, post-discharge home visits and the three-day skilled nursing facility rule.
On its website, KentuckyOne Health Partners ACO told consumers it would be terminating its participation in Next Gen as of March 28. It gave no reason for the departure but told beneficiaries that while they would receive the same excellent care and have access to their network of providers, some benefits would no longer be available.
These include the termination of a $25 coordinated care reward for getting an annual wellness visit; the end of a waiver requiring Medicare beneficiaries to have a prior three-day inpatient stay before qualifying for a skilled nursing facility; the end of comprehensive post-discharge care from the hospital to the home; and the termination of telehealth services.
CMS Innovation Center's Next Generation ACO Model was designed to test whether strong financial incentives for ACOs could improve health outcomes and reduce expenditures.
"Next Generation ACOs are at the leading edge of improving care for Medicare beneficiaries and the model continues to test innovative approaches, and generates important data and lessons for CMS," the agency said.
