A new study backs up what federal officials recently revealed: Physician-led accountable care organizations (ACOs) have significantly outperformed organizations led by hospitals, leading to $257 million in savings for Medicare in 2015.
Hospital-led ACOs, on the other hand, actually cost Medicare money that year.
Those conclusions — from a study by Harvard Medical School researchers published online September 5 in the New England Journal of Medicine — are similar to the most recent report from the National Association of ACOs (NAACOS). The NAACOS report estimated that in 2017, 472 ACOs participating in the Medicare Shared Savings Program (MSSP) and covering 9 million people, saved Medicare $314 million.
The Harvard study, led by J. Michael McWilliams, MD, the Warren Alpert Professor of Health Care Policy and professor of medicine at Harvard Medical School, Boston, Massachusetts, examined the MSSP's first 3 years, from 2012 to 2015. The study's conclusion also lines up with a recent assertion by federal officials that physician-led ACOs seem to be more successful at restraining costs.
ACOs are groups of local physicians, hospitals, and other providers that work together and take responsibility for the quality and cost of patient care.
The Harvard researchers also report that their analysis suggests ACOs that only share the possible benefits but not the risks with Medicare still have the ability to reduce Medicare spending.
That flies in the face of a policy proposed in August by the Centers for Medicare & Medicaid Services (CMS). The federal government said it wants to curb ACO contracts that share only in savings, saying that inadequate incentives have led to a steep rise in bonus payments without attendant savings.
But McWilliams and colleagues suggest that any ACO policies that limit bonus payments to providers participating in models that impose downside risk may be too restrictive. "Moreover, our findings suggest distinctive benefits from MSSP participation that could erode if policy changes, such as requiring ACOs to assume downside risk after fewer years of participation, cause more ACOs to leave the program," they write.
Longer Participation Equals More Savings
The researchers found that the longer a physician group participated in an ACO, the higher the savings it could generate. They studied a random 20% sample of Medicare beneficiaries who were continuously enrolled in the federal health program. They compared those who had a primary care visit at an ACO with those who were not in ACOs, and also divided physician-led from hospital-integrated ACOs.
For physician-led ACOs, the reduction in spending was $474 per beneficiary for groups that began in 2012, $342 for those that started in 2013, and $156 for those that began in 2014.
For each category, the average savings was significantly less for the hospital-led ACOs, at $169 per beneficiary for the 2012 group, $18 for the 2013 group, and $88 for those that started in 2014.
ACOs led by doctors achieved savings in acute inpatient care, post-acute care, home healthcare, and outpatient care in hospital-owned settings. Emergency department visits also declined. Those non–office-based care reductions partially offset increases in spending on office-based outpatient care.
Meanwhile, hospital-led ACOs had no reductions in spending in any care area.
The authors acknowledged some limitations, including that the savings estimates for the 2013 group may have been partially due to a change in coding practices. They also focused on just one aspect of ACO organizational structure, but "many other factors may have contributed to differences in savings," they write.
Despite these and other limitations, "a resampling analysis suggested that financial independence from hospitals was a prominent predictor of savings," said the authors.
The study was supported by a grant from the National Institute on Aging. The authors have disclosed no relevant financial relationships.
N Engl J Med. Published online September 5, 2018. Full text
Medscape Medical News © 2018 WebMD, LLC
Send comments and news tips to news@medscape.net.
Cite this: Physician-Led ACOs Outperformed Hospital-Led Organizations - Medscape - Sep 06, 2018.
Comments