Just over a week after the Supreme Court's ruling to uphold the Affordable Care Act, the Centers for Medicare & Medicaid Services has announced 89 new shared-savings Medicare accountable care organizations, bringing the overall Medicare ACO total to more than 150. The new group of shared savings ACOs was already in the works and, with an official start date of July 1, 2012, it's unlikely that the ruling would have nixed plans to launch these newest players. CMS reports that the 89 ACOs will include 1.2 million Medicare beneficiaries living in 40 states and Washington, D.C.

There appears to be little to no duplication between the 89 new ACOs and the first shared-savings ACOs that launched in April 2012. However, because some of the ACOs operate in the same regions of the country, a number of physicians could be participating in more than one accountable care organization. This may be particularly true in California, where virtual physician organizations called Independent Practice Associations are deeply entrenched.

The CMS statement points out that nearly half of the new ACOs are physician-led organizations that serve less than 10,000 Medicare enrollees and that this demonstrates that smaller organizations are interested in operating as ACOs (CMS). That may be, but their interest, in no small part, is also driven by necessity. Unlike the previous group of shared-savings ACOs, many of the new organizations will operate in multiple states. Meridian Holdings, for example, involves only 60 physicians but will include beneficiaries from seven states and Washington, D.C.

While the model is evolving, ACOs are clearly here to stay. CMS will accept new ACO applications on an annual basis. The question that remains is whether these so called shared-savings ACOs can live up to their name and how their success will compare to commercial accountable care organizations. Stay tuned!

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