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A coalition of 11 groups representing accountable care organizations (ACOs) and other health care stakeholders wants the government not to consider “anomalous” Medicare spending that is outside ACOs’ members control when determining if an ACO has exceeded its annual spending benchmarks
In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services (CMS), the coalition members acknowledged CMS’s recent efforts to promote value-based care. They added, however, that including unusually high claims penalizes ACOs and jeopardizes participation of doctors, medical practices, and other health care organizations in them.
The letter was prompted by a spike in spending on two catheter codes, from $153 million in 2021 to $3.1 billion in 2023, with nearly all the increase coming from just 10 suppliers. This resulted in some ACOs spending more on catheters than was anticipated when determining their financial benchmarks, and thus a loss of shared savings.