Last week the conversation about financial risk for providers in ACOs took on a decidedly different and more contentious tone. After months of CMS reports of ACO growth and success, while retreating on MIPS quality reporting requirements as concessions to “provider burden,” CMS signaled that they were finished waiting for providers to accept financial risk under Value-Based Health Care.
With a third of Medicare patients served by an ACO and an even higher number of patients receiving health care via private sector ACOs, the industry seems on track to adopt ACOs as the preferred model of health care contracting and reimbursement. All that tipping point talk, however, cannot mask a countervailing trend: while providers have been willing to set up and participate in ACOs, they have not been moving quickly to accept financial risk. This is even more the case for Medicare ACOs than private ACOs, which tend to have some down-side risk.