SCOTTSDALE, Ariz., Feb. 10, 2017 /PRNewswire/ — Darwin Health today announced the winners of its 2016 ACO of the Year Awards. Darwin’s proprietary model, which ranks accountable care organizations (ACOs) on quality and financial performance, utilized the most recently available data (2015) from the Centers for Medicare and Medicaid Services (CMS). Unlike the CMS overall quality score, Darwin’s methodology does not award bonus points for year-over-year improvement.

“In these uncertain times, when the Affordable Care Act is facing mounting challenges, we thought it was important to put a spotlight on high-performing organizations,” said Darwin Health CEO John Marchica. “Some good ideas have come from the ACA, which is clearly demonstrated by the many accountable care organizations that are improving the quality of care while saving money for American taxpayers.”

Darwin’s National ACO of the Year, the Rio Grande Valley Accountable Care Organization, ranked first in quality and had $21.6 million in net savings in 2015, resulting in $12.6 million in shared savings for the organization.

“A culture of continuous improvement was promoted since inception,” said Joseph Peña, MD, CEO and medical director for RGV ACO Health Providers. “Our efforts in an intense care coordination program, working together with the IT department to improve quality and decrease costs, have paid off.”

Medicare Shared Savings Program (MSSP) ACOs eligible for an ACO of the Year Award had to demonstrate exceptional quality as well as shared savings. Darwin has selected one national, four regional and nine divisional ACOs as 2016 winners.

Memorial Hermann ACO had the greatest net savings of all MSSP ACOs, at $89.1 million, but scored only slightly above average on Darwin’s overall quality score. Coastal Carolina Quality Care, which ranked third nationwide for quality, had shared losses of just over $1 million. Marchica said in the spirit of The Triple Aim, it was important that both quality and financial performance be included to be eligible for the ACO of the Year award.

The 2016 ACO of the Year winners are:

National

Rio Grande Valley ACO Health Providers, LLC

Regional

Midwest: Kansas Primary Care Alliance

West: Commonwealth Primary Care ACO, LLC

Northeast: Central Maine ACO

South: RGV ACO Health Providers

A complete list of award recipients can be found here.

About Darwin Health

Scottsdale, AZ-based Darwin Health is a research-based management consulting firm focused on health care delivery models—physician groups, health systems and home health—and emerging payer models, like accountable care organizations and bundled payments. We work with our clients to create partnering opportunities and identify ways to improve patient care.

Contact:

John Marchica
Darwin Health @ (480) 305-2059 or jm@darwinhealth.net

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In August, the Centers for Medicare and Medicaid Services (CMS) released the latest round of performance results for the Medicare accountable care organization (ACO) programs (see Medicare Accountable Care Organizations 2015 Performance Year Quality and Financial Results). CMS estimates that, in total, the Medicare ACO programs produced $466 million dollars in savings during 2015, representing .0007% of the $648 billion in Medicare spending (ACO payouts have exceeded savings resulting in a program net loss). During that period, CMS paid $645.5 million in ACO bonuses. But, those savings and bonus payments vary across ACOs. (For a refresher on Medicare ACO programs, their…

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive.

I decided to do a crude check. I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

Why does this fact barely seem to register publicly? Well, as a doctor, I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years. More than a decade ago, I saw a young woman in the emergency room who had severe pelvic pain. A standard X-ray showed nothing. I examined her and found signs of pelvic inflammatory disease, which is most often caused by sexually transmitted diseases. She insisted that she hadn’t been sexually active, but I didn’t listen. If I had, I might have ordered a pelvic CT scan or even recommended exploratory surgery to investigate further. We didn’t do that until later, by which time the real source of her symptoms, a twisted loop of bowel in her pelvis, had turned gangrenous, requiring surgery. By contrast, I can’t remember anyone I sent for an unnecessary CT scan or operated on for questionable reasons a decade ago. There’s nothing less memorable.

It is different, however, when I think about my experience as a patient or a family member. I can readily recall a disturbing number of instances of unnecessary care. My mother once fainted in the Kroger’s grocery store in our Ohio home town. Emergency workers transported her to a hospital eighty miles away, in Columbus, where doctors did an ultrasound of her carotid arteries and a cardiac catheterization, too, neither of which is recommended as part of the diagnostic workup for someone who’s had a fainting episode, and neither of which revealed anything significant. Only then did someone sit down with her and take a proper history; it revealed that she’d had dizziness, likely from dehydration and lack of food, which caused her to pass out.

I began asking people if they or their family had been subject to what they thought was unnecessary testing or treatment. Almost everyone had a story to tell. Some were appalling.

My friend Bruce told me what happened when his eighty-two-year-old father developed fainting episodes. His doctors did a carotid ultrasound and a cardiac catheterization. The tests showed severe atherosclerotic blockages in three coronary arteries and both carotid arteries. The news didn’t come as a shock. He had smoked two packs of cigarettes a day since the age of seventeen, and in his retirement years was paying the price, with chronic lung disease, an aortic-aneurysm repair at sixty-five, a pacemaker at seventy-four, and kidney failure at seventy-nine, requiring dialysis three days a week. The doctors recommended doing a three-vessel cardiac-bypass operation as soon as possible, followed, a week or two later, by surgery to open up one of his carotid arteries. The father deferred the decision-making to the son, who researched hospitals and found a team with a great reputation and lots of experience. The team told him that the combined procedures posed clear risks to his father—for instance, his chance of a stroke would be around fifteen per cent—but that the procedures had become very routine, and the doctors were confident that they were far more likely to be successful than not.