The revelation that nine of the 32 accountable care organizations in Medicare's Pioneer program might leave it -- four of them to join the regular Medicare shared savings program (MSSP) -- has raised some eyebrows in the healthcare industry. The reason is that the Pioneer ACOs, which are among the most advanced healthcare organizations, are expected to take downside risk -- meaning they can lose money -- sooner than the ACOs in the MSSP, which have only upside risk -- meaning they share savings but not losses -- for the first three years. So the departure of nearly a third of the Pioneers would raise some questions about the viability of the government's plan to get providers to take financial responsibility for care.
