Almost half of physicians in Shared Savings ACOs aren't aware of their downside risk

Nearly 50 percent of physicians participating in Medicare Shared Savings Program ACOs could be losing money without knowing it, according to a survey published in Health Affairs.

The survey polled more than 1,400 physicians across three ACO models — Pioneer, MSSP and Advance Payment Model — between September 2014 and April 2015. Of the 405 physicians participating in MSSP ACOs, 49.5 percent did not know if they were financially at risk by participating in the ACO. Similarly, 49.7 percent of Pioneer ACO participants were unsure of their risk and 36.5 percent of AP ACOs were unaware of their risk.

Similar proportions of participating physicians didn't know if they were eligible to receive shared savings: 45.5 percent of physicians in MSSP ACOs, 47.2 percent in Pioneer ACOs and 32.9 percent in AP ACOs, according to the survey.

The lack of awareness about the models may be due to the overall apathetic attitude physicians in the survey expressed about ACOs. Physicians indicated they were only moderately convinced ACOs could be successful in improving quality and reducing costs of care, according to the survey.

Physicians participating in AP ACOs were most likely to have a positive perception of the model of care and its positive effect on patient care. The authors suggest this could be linked to the type of physicians that participate in the various models — AP ACO physicians are more likely to be primary care physicians in small or rural practices. Physicians part of AP ACOs also were the most involved in the decision to join the model, according to the survey, which could influence their perception of its success. For instance, 65 percent of physicians in AP ACOs reported involvement in the decision to participate, compared to 30 percent of physicians in MSSP ACOs and 19 percent of physicians in Pioneer ACOs.

"[T]he results of our survey suggest that many participating physicians' views are not aligned with ACO goals and that the physicians are divided as to whether or not the ACO model is effective," the authors wrote. And while most physicians surveyed noted a general move away from fee-for-service, they didn't necessarily feel ACOs were the driver of this. "[T]these physicians seem largely comfortable with their own ability to adapt to the shift toward value-based payment and may not view the ACO model as necessary to their success in doing so," the report reads.


More articles on accountable care:

ACOs could help physicians earn up to 25% positive payment adjustment under MIPS
Primaria Health adds to primary care network, launches ACO
ACOs saved $345 per patient in 2012, study finds

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