CMS announces first-year results from Pioneer ACO program   07/16/2013
Thirteen of the 32 Pioneer Accountable Care Organizations produced gross Medicare savings of $87.6 million in 2012, the first year of the program, while two shared in losses totaling about $4.0 million, the Centers for Medicare & Medicaid Services announced today. The Pioneer model tests a shared savings and shared losses payment arrangement, with higher levels of rewards and risks than in the Medicare Shared Savings Program. Costs for the more than 669,000 beneficiaries aligned to Pioneer ACOs grew by 0.3% in 2012, compared with 0.8% for other similar beneficiaries, CMS said. All Pioneer ACOs earned incentive payments for reporting quality measures, performing better overall on 15 clinical quality measures for which comparable fee-for-service data are available, the agency said. For example, 25 Pioneer ACOs generated lower risk-adjusted readmission rates for their aligned beneficiaries than the benchmark rate for all Medicare fee-for-service beneficiaries. Seven Pioneer ACOs that did not produce savings intend to apply to the Medicare Shared Savings Program, and two Pioneer ACOs intend to leave the program, CMS said. The agency expects to have first-year MSSP results later this year. 
GAO recommends action to address self-referral of biopsy services   07/16/2013
Physicians generally make more referrals for anatomic pathology (biopsy) services under Medicare Part B when they or a family member has a financial interest in the entity performing the service, according to a report released yesterday by the Government Accountability Office. In 2010, this higher referral rate cost Medicare about $69 million in additional anatomic pathology services, GAO estimates. The number of self-referred biopsy services more than doubled between 2004 and 2010, while the number of non-self-referred services grew about 38%, the agency found. Three provider specialties – dermatology, gastroenterology and urology – accounted for 90% of the self-referred services in 2010. In the report, the Department of Health and Human Services agreed with a GAO recommendation that the Centers for Medicare & Medicaid Services address higher use of self-referral through a payment approach, but did not agree with GAO’s recommended approach to doing so.
Hospitals reminded to complete RACTrac survey by Friday   07/16/2013
The AHA encourages all hospitals to submit data by July 19 to its quarterly RACTrac survey. The free web-based survey helps AHA gauge the impact of Medicare's Recovery Audit Contractor program on hospitals and advocate for needed changes. To register for the survey or for technical assistance, participants should contact RACTrac support at (888) 722-8712 or For more on the survey, including the latest results from the first quarter of this year, visit