Hospitals Threaten Obamacare Savings by Exiting Program
By Alex Wayne – Jun 29, 2013 3:09 PM ET
Almost a third of 32 hospitals and health systems involved in an experiment aimed at changing the way medical providers are paid may exit the program, a potential threat to the Affordable Care Act’s ambitious cost-saving goals.
Medicare’s “Pioneer” program is designed to save money by more efficiently managing care for patients with chronic diseases, such as diabetes and dementia. The providers agreed to a three-year plan to forgo traditional fee-for-service payments, where hospitals charge for every procedure, and instead get a fixed monthly stipend for individual patients.
Begun in January 2012, Pioneer is one of several programs involving 252 providers created under the law to experiment with new payment models. Nine Pioneer members have told the U.S. they may exit, said Brian Cook, a Centers for Medicare and Medicaid Services spokesman. At least four may join other accountable-care programs that carry less financial risk, he said.
Depending on the number of patients involved, “it really shows a critical cost-containment approach in the Affordable Care Act is running into real problems,” said Robert Blendon, a health-policy professor at Harvard University’s School of Public Health, in a telephone interview today.
The experimental programs were set up under the law to save Medicare, the U.S. insurer for the elderly and disabled, as much as $940 million through 2015. Hospitals were projected to gain as much as $1.9 billion in bonus payments under the law.
