Primary-care docs reaping the most from shared-savings ACOs

For the second year, the CMS has awarded bonuses to 1 in 4 accountable care organizations working under a Medicare model intended to spur providers to deliver lower-cost care. They will share $422 million out of the $833 million they collectively saved the government in 2014.

ACO networks get to decide for themselves how to distribute the money, and primary-care doctors appear to be benefiting the most, according to a review of disclosures by ACOs participating in Medicare's Shared Savings Program. Those individual management decisions are a matter of much scrutiny and debate in the industry and among policymakers. 

Incentives paid directly to providers can be a powerful way to change the practice of medicine as doctors alter their behavior to earn payouts. But research on incentives has so far yielded mixed findings. 

“We don't have a good distribution model for ACO savings,” said Dr. Kavita Patel, managing director of clinical transformation at the Brookings Institution's Center for Health Policy, citing a study published this month. 

The Obama administration made the announcement last week that 97 of 353 Medicare ACOs earned bonuses in 2014. Most of them were in the Affordable Care Act's Shared Savings Program, which rewards participants that hold down healthcare costs while meeting quality targets. 

Primary-care providers in particular are viewed as linchpins of the ACO model because they are responsible for coordinating care. Yet among the first cohort in the program, those that specifically singled out primary-care doctors for incentive awards were equally as likely to see no bonus as they were to earn payouts.

Some of the participants said they only distributed those rewards to individuals after recovering expenses and upfront investments. A few pledged to hold some bonuses in reserve in case of poor future performance. But most of them are reinvesting a percentage of their bonuses and divvying up the rest among primary-care doctors, specialists and hospitals.