Medicare Shared Savings Program Reduces Postacute Spending

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Accountable Care Organization models also reduced ER and primary care visits.
Accountable Care Organization models also reduced ER and primary care visits.

HealthDay News – Participation in the Medicare Shared Savings Program (MSSP) is associated with an overall reduction in post-acute spending, and the performance of Oregon's Medicaid Accountable Care Organization (ACO) model is similar to that of Colorado, according to 2 studies published online in JAMA Internal Medicine.1-3

J. Michael McWilliams, MD, PhD, from Harvard Medical School in Boston, and colleagues examined changes in post-acute care spending and use of post-acute care associated with provider participation in ACOs in the MSSP. The researchers found that for the 2012 cohort of 114 ACOs, MSSP participation correlated with an overall decline in post-acute spending; this was driven by reductions in acute inpatient care, discharges to facilities vs home, and length of stay in a skilled nursing facility.

K. John McConnell, PhD, from the Oregon Health & Science University in Portland, and colleagues compared the performance of Oregon's and Colorado's Medicaid ACO models. The researchers found that in both states, standardized expenditures for selected services decreased during 2010 to 2014; these reductions did not differ significantly between the states. There were reductions in emergency department and primary care visits, and improvements in acute preventable hospital admissions, 3 of 4 measures of access, adolescent well-care visits, adult access to preventive ambulatory care, and in one of 4 measures of appropriateness of care with Oregon's model.

"Oregon's model, marked by a large federal investment and movement to global budgets, was associated with improvements in some measures of utilization, access, and quality, but Colorado's model paralleled Oregon's on several other metrics," the authors wrote.

Disclosures: One author from the McWilliams study reported serving as an expert witness for the Federal Trade Commission, and 2 authors disclosed financial ties to the health care industry.

References

  1. McWilliams JM, Gilstrap LG, Stevenson DG, et al. Changes in postacute care in the Medicare shared savings program [published online February 13, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.9115
  2. McConnell KJ, Renfro S, Chan BKS, et al. Early performance in Medicaid Accountable Care Organizations. A comparison of Oregon and Colorado [published online February 13, 2017]JAMA Intern Med. doi: 10.1001/jamainternmed.2016.9098
  3. Colla CH, Fisher ES. Moving forward with Accountable Care Organizations. Some answers, more questions [published online February 13, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.9122
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