Accountable care organizations, the healthcare delivery model created by the Affordable Care Act in an effort to reduce Medicare costs while improving coordination and quality of care, typically rely on primary care providers to steer the boat.
But an ACO's ability to reduce spending may require a specific balance of involvement from medical specialists, such as a cardiologist, orthopedist or neurologist. That is the central finding of a UMass Amherst study by health service researchers published in JAMA Network Open.
WHAT'S THE IMPACT
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Four researchers, led by UMass Amherst PhD student Vishal Shetty, examined data on 620 ACOs from the Centers for Medicare and Medicaid Services' Shared Savings Program to investigate the association between office visits to medical specialists and healthcare spending. The data covered more than five years, from April 2012 through September 2017.
ACOs in which 40 to 45% of the patient visits were provided by a specialist had $1,129 lower annual spending per beneficiary than ACOs with a specialist visit proportion of less than 35 percent, and $752 lower annual spending per beneficiary than ACOs with a specialist visit proportion of 60% or more.
The numbers support the notion of balance between primary care providers and specialists, particularly when it comes to high-risk patients with chronic conditions. While the team did not expect to see more than $1,000 lower spending per patient, they did hypothesize that balance factoring into optimal cost savings or lower expenditures.
The ACO model shifts the financial responsibility to healthcare providers by establishing incentives for value-based care over volume. The idea is that better coordination of care will simultaneously reduce unnecessary medical services, improve health outcomes and lower costs. Under the Medicare Shared Savings Program, ACOs receive a bonus if their spending comes in below a benchmark.
The researchers also found that as the proportion of specialist visits increased in an ACO, the number of emergency department visits, hospital discharges and skilled nursing facility discharges decreased.
To more consistently curb health care costs, the study suggests policymakers may want to consider adding medical specialists to ACO governance and creating better financial incentives for specialists in the ACO model.
THE LARGER TREND
It's been roughly six months since CMS issued the final rule for the overhaul of ACO payments.
The rule stipulates that to remain an ACO, the organizations will be required to assume risk sooner, ending the six-year period in which ACOs can stay in an upside-only risk model. The rule, which governs the Medicare Shared Savings Program, is expected to save Medicare about $2.9 billion over 10 years.