Some ACOs Are Gaming the System: MedPAC

Accountable Care Organizations may be purposefully removing clinicians with high-cost patients and bringing in clinicians with low-cost patients without adjusting their benchmark rates, according to Medicare Payment Advisory Commission staff briefing. Under the program, if the ACO performance year spending is less than the agreed-upon benchmark, then there will be shared savings between the ACO and Medicare. MedPAC says the growing risk of unwarranted shared savings payments to ACOs may put Medicare savings at risk. Currently, CMS calculates the benchmark based on the clinicians' taxpayer identification number and does not calculate benchmark changes in the national provider identifiers billing; however, a clinician can switch which TIN to bill under - resulting in unwarranted savings. MedPAC will vote in April on a recommendation to use the same set of NPIs to compute both performance year and baseline spending. For the full MedPAC presentation, click here.