Medicare Called ‘Vulnerable’ on Coordinated Care Payments

The groups of doctors, hospitals, and other clinicians that provide coordinated care for Medicare beneficiaries could be receiving unwarranted payments, potentially jeopardizing the modest savings that the groups are netting for Medicare.

Those provider groups, known as accountable care organizations (ACOs), receive bonus payments from Medicare if they can keep their assigned patient population healthy and the cost of their care below agreed-upon financial thresholds, or benchmarks.

But ACOs could be gaming the system by shedding high-cost patients and the physicians who care for them without adjusting their benchmarks to reflect the changes, analysts at the Medicare Payment Advisory Commission ...