Accountable care organizations (ACOs) are the largest experiment in payment reforms, but the incentive structure may lead participating physician groups to select fewer vulnerable patients. In a new study in JAMA Network Open, my colleagues and I tested whether physician groups changed their proportions of black patients and patients with low socioeconomic status after joining the Medicare ACO, and found that – in general – they did not.
Accountable care organizations (ACOs) figure prominently in Medicare’s shift “from volume to value.” Providers in ACOs assume financial accountability for overall quality and costs for a defined patient population, and they earn shared savings for containing spending below a defined benchmark. To date, most ACOs have focused on primary care, outpatient services, and care management for patients with chronic medical conditions, such as diabetes and heart failure.
Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations
Abstract [from journal]
Importance: The incentive structure of accountable care organizations (ACOs) may lead to participating physician groups selecting fewer vulnerable patients.
Objective: To test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining the ACO.
Design, Setting, and Participants: This retrospective cohort consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician...
The growth of health care costs remains a serious concern in the United States. Slowing this growth involves understanding what drives health care costs and how to target those drivers effectively. In this brief, we review the relative importance of different health care cost drivers, including insurance benefits design, price inflation, provider incentives, technological growth, and inefficient system performance. We analyze the impact of these factors on the growth of health care spending in the last decade, which has been concentrated in hospitals and felt most acutely in the private market.
Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?
Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations
Abstract [from journal]
Importance: An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes given the prevalence of LEJR among patients receiving care at ACO participant organizations and potential overlap in care redesign strategies adopted under the 2 payment models....
[Reposted: Paula Chatterjee, Allison K. Hoffman, Rachel M. Werner. Shifting the Burden? Consequences Of Postacute Care Payment Reform On Informal Caregivers, Health Affairs Blog, September 5, 2019. https://www.healthaffairs.org/do/10.1377/hblog20190828.894278/full/: Copyright ©2019 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
Should providers participating in accountable care organizations (ACOs) be exempt from existing regulations that prevent financial conflicts of interest in physician referrals? On the one hand, these regulations, collectively known as the Stark Law, can impede efforts to coordinate care across providers and facilities. On the other hand, ACOs and other alternative payment and delivery models do not necessarily obviate the need for regulations that prohibit physician kickbacks or self-referrals.
Health system reforms, such as value-based payment, can worsen or improve existing health care disparities, even if policy changes do not target the disparities themselves.
Effect of Hospital and Post-Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending
Abstract [from journal]
Objective: To test for differences in patient outcomes when hospital and post‐acute care (PAC) providers participate in accountable care organizations (ACOs).
Data/Setting: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO‐participating hospitals and PAC providers.
Design: We compared changes in outcomes
Do Changes in Post-Acute Care Use at Hospitals Participating in an Accountable Care Organization Spillover to All Medicare Beneficiaries?
Abtract [from journal]
While early evidence suggests that Medicare accountable care organizations (ACOs) may reduce post-acute care (PAC) utilization for attributed beneficiaries, whether these effects spill over to all beneficiaries admitted to hospitals participating in ACOs stray is unknown.
The objective of this study was to evaluate whether changes in PAC use and Medicare spending spill over to all beneficiaries admitted to hospitals participating in the Medicare
Practice transformation and payment reform are defining features of contemporary health policy debates. The story goes like this: new provider organizations, such as Accountable Care Organizations (ACOs) are transforming care delivery from fragmented and volume driven to integrated and optimized for quality; meanwhile, innovative payment models, such as bundled payments and risk-based contracting, herald a national transition from fee-for-service (FFS) to value-based payments.