ACOs Failing Transparency Requirements

Accountable Care Organizations (ACOs) in Medicare’s Shared Savings Program are supposed to make public not only how much money they saved, but also how they’ll spend the savings.

According to a new report published in the American Journal of Managed Care (AJMC), just over half of the ACOs in the program shared what they would do with their savings. For 2012-2013, those ACOs generated $383 million in savings to Medicare, with the 52 highest performing ACOs generating $315 million of those savings.

According to the report’s researchers, John Schulz, Matthew DeCamp, M.D., and Scott A. Berkowitz, M.D., of the 52% of ACOs that detailed spending plans on their websites, 63% said they would give the savings to their member primary care providers, specialists or hospitals. Meanwhile, 33% said they would spend that savings on infrastructure.

Health Care Finance News reported that the authors also said ACOs that included a hospital planned to give more to participating entities than ACOs that did not include a hospital.

While only 52% of program participants reported their spending details, 84% offered some “vague” information about their savings distribution, said the researchers.

In the AJMC article published online the authors said “There are several possible explanations for this finding. First, all of the ACOs without a website were in the January 2014 start date, and these ACOs might have created websites since the study was conducted mid-year, or the websites existed but were unable to be found with normal search functions. Second, since initial public reporting guidance was issued in 2012, CMS has issued updated guidance in September 2014 that explicitly clarifies that ACOs must adhere to the reporting format of CMS.”

The extra transparency is supposed to give patients an opportunity to see if those dollars are being used to directly affect them in the form of new programs or indirectly by supporting physician development or infrastructure, the authors wrote. At the same time, policy makers could use the results to better understand where ACOs see the biggest drivers of their successes.

Ultimately, the authors said research should continue as the program matures to be able to tell which plans for spending shared savings better benefit the ACOs. “There appears to be no single shared savings distribution plan determinate of ACO success. Continued investigation of predictors for generating savings is needed to inform future shared savings models.”