Pilot program could save millions in Medicare costs

Sep 19, 2014 | Hospital Finance Efficiency

An ongoing experiment with a new health care business model in Massachusetts has saved millions of dollars so far while improving the care participating patients receive. According to the Boston Globe, providers have set up patient pools called pioneer accountable care organizations, where they earn incentives for coordinating care, cutting unnecessary tests and procedures, and keeping patients healthy.

The source explains that if providers exceed the established budget, they must pay a penalty. On the other hand, if the providers come in below budget, they then split the savings with Medicare. The Globe also published a list highlighting the savings experienced by the pioneer accountable care organizations:

  • Steward Health Care: $19.2 million
  • Israel Deaconess Medical Center: $17.3 million
  • Mount Auburn Hospital: $3.6 million
  • Partners HealthCare: $3.3 million

Perhaps even more impressive is that these organization all also saw higher marks in the quality of care provided. 

"It's one thing to deliver savings," Dr. Sanjay Shetty, president of Steward's doctors group, told the source. "It's another thing to deliver savings while improving your quality scores."

As of yet, the Centers for Medicare & Medicaid Services have had no comment on the specific practices of these organizations that led to such significant savings. 

To improve the quality of care while seeking to improve cost efficiency, pioneer accountable care organizations were established under the Affordable Care Act. However, Dr. Gregg Meyer, chief clinical officer, for Partners Healthcare, told the source that more time is needed to determine how well the program is working. 

While this is exciting news, many care facilities are already experiencing challenges brought upon by issues with cash flow, and can not wait for a new industry model to be introduced. The decision to outsource accounts receivable can provide more immediate relief, as well as a more manageable claims load for in-house staff.