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August 13, 2024

Physicians Accountable & Their Beneficiaries Actions

The concept of ACOs has been around since 2005. The ACA strengthened the commitment of CMS to expand ACO programs for Medicare. Currently, there are over 480 ACOs participating in CMS Medicare Shared Savings Program (MSSP). ACOs are responsible for the health outcomes for beneficiaries attributed to their organization. Therefore, ACOs will share savings (expenditures less than predicted) or return payments back to CMS based on their patient population.

Is it fair for CMS to hold providers accountable for the actions of their beneficiaries? For example, a physician counsels patients about weight loss and a healthy diet. Only a portion of their patients will change their eating and exercise habits. For those who do not, is it fair to hold the provider responsible for the patient’s future healthcare expenditures? Should the patient be held accountable? How could CMS hold the patient accountable for their decision to ignore physician instruction?

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