Stephen Nuckolls: 2 Years Isn't Enough Time for an ACO to Take on Risk

The proposed changes to the Medicare Shared Savings Program that move accountable care organizations (ACOs) to take on risk in just 2 years is not going to be enough time for most ACOs, although some may be ready in that time, said Stephen Nuckolls, CEO of Coastal Carolina Quality Care.

Previous research has shown that ACOs that are doing it longer, perform better. Do you think the shorter 2-year timeline to take on risk provides enough time for ACOs to figure it out?
[CMS has] drastically shortened the time period from 6 years to 2 years. I know for our ACO, we did not achieve savings in the first 3-year contract period, and if we had been then required to take on risk after 2 years after just seeing just the first year’s results, I don’t think our ACO would still be an ACO. We would have dropped out of the program.

I don’t believe that’s enough time. And I think we were able to move a lot more quickly as a small ACO than some of the larger systems. I think ACOs are going to need more time to get ready for risk.

Some may be ready in that period of time, but there are many different things that go on with how you formulate the benchmark and how the benchmark impacts local markets, and it’s less about being ready for risk and knowing what the risks are, evaluating the risks to see what your odds of success are and what the probabilities are.
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