payment reform Affordable Care Act achieved initial gains: ; study
accountable care organizations that joined the Shared Savings Program Medicare (MSSP) when it was launched in 2012 managed modest savings while maintaining or improving performance on measures of quality of patient care in 2013, the first full year of the program, researchers from Harvard Medical School found in the first scrutiny this program payment key reform health care. These early adopters spending fell 1.4 percent in 2013 compared to a control providers outside the ACO group in the same areas, representing a reduction of $ 238 million in spending.
These savings provide further evidence of the first promising results of the initiatives of organizations responsible for care in Medicare, which the MSSP is the largest. However, the results also have a more complex pattern of savings across different types and cohorts of ACO history. The results are published today in the New England Journal of Medicine .
ACO are groups of health care providers who agree to provide care to a patient population with an overall budget known as a benchmark. ACO holding expenditure below the reference point and a good performance on measures of quality of participation in care savings. Unlike other programs such as Pioneer ACO model, the MSSP participants are not required to reimburse Medicare if spending is higher than the benchmark. The first two cohorts of provider groups (220 in total) entered the MSSP in mid-2012 or early 2013. Since then, the program has expanded and now includes more than 430 participants.
While the ACO that joined in 2012 spending cut by $ 238 million, the next cohort of ACO who joined in 2013 achieved any savings in its first full year in the program, suggesting that the early success the first participants can not be replicated by subsequent waves of ACO that have joined the MSSP. In addition, because Medicare paid $ 244 million in savings bonds ACO share in the first two groups, the lower spending in the cohort of 2012 was not a net savings to Medicare.
“These results suggest that the ACO without downside risk can achieve savings, but the savings to Medicare and society can be a slow development,” said J. Michael McWilliams, Associate Professor Warren Alpert Care Health at HMS and lead author of the study. “However, incentives for the ACO to reduce spending are currently very weak, so the savings can be accelerated if the incentives are strengthened.”
In particular, the current method for establishing an ACO reduces their incentives to save. Specifically, if an ACO reduces spending now is penalized with lower after reference point. According to the authors, severing the link between the reference point of an ACO and previous savings could go a long way towards satisfying ACO properly to curb wasteful practices and allowing yields needed for ACO to invest in systems more efficient care.
Researchers also found that independent primary care groups participating in the MSSP achieve significantly higher savings groups integrated hospitals.
“Some have supposed that the formation of a system of large hospitals that has a lot of outpatient practices is a prerequisite for successful ACO,” McWilliams said. “It does not seem to be the case.”
One reason for this finding, the authors note, is that groups of independent doctors have greater incentives to prevent hospitalizations groups owned by the hospital, as their savings bonds shared do not offset by gains the organization forgone by reducing hospital care.
Finally, the authors found that the ACO in the MSSP with high costs for their region achieves greater savings ACO with spending below the regional average. This suggests that the ACO with more opportunities to reduce spending had an easier time doing so. Recently, the Centers for Medicare and Medicaid proposed transition to a benchmark system in which an ACO is mainly based on average expenditure in their region. Because the participation of high spending on voluntary ACO MSSP is particularly valuable to reduce overall spending on Medicare, the authors warn against the movement of those regional reference points too fast. Doing so could lead to ACO with high costs for their region to exit the program, thereby decreasing savings throughout the program .
“These early results are encouraging in general,” McWilliams, who is also a practicing general internist and associate HMS medicine at Brigham and Women’s Hospital professor said. “However, based on the initial success of the Medicare ACO models will require greater incentives and rigorous evaluations to identify consistently successful ACO groups whose models and strategies of the organization can be disseminated.”
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