Benchmarking Implications: Analysis of Medicare Accountable Care Organizations Spending Level and Quality of Care. Issue 6 (November 2018)

• Record Type: Journal Article
• Authors: Hong, Young-Rock; Kates, Frederick; Song, Soon Ju; Lee, Nayoung; Duncan, R. Paul; Marlow, Nicole M.
• Is Part Of: Journal for healthcare quality. Volume 40:Issue 6(2018)
• Publication Date: 2018-11
• Subjects: Accountable Care Organization -- Medicare shared savings program -- value-based payment -- quality of care delivery -- fee-for-service; Medical care -- Quality control -- Periodicals; Quality assurance -- Periodicals; 362.1
• DOI: 10.1097/JHQ.0000000000000123
• Languages: English
• ISSNs: 1062-2551

Abstract

Abstract : ABSTRACT: Early evidence has shown that Accountable Care Organizations (ACOs) have achieved some success in improving the quality of care and reducing Medicare costs. However, it has been argued that the ACO rewarding model may disproportionately affect relatively low-spending (LS; considered as efficient) organizations that have fewer options to cut unnecessary services compared with high-spending (HS; inefficient) organizations. We conducted a cross-sectional retrospective study to compare ACO financial and quality of care performance between HS-ACO and LS-ACO. After adjusting for ACO organizational factors and beneficiary characteristics, we found that HS-ACOs generated greater savings per beneficiary than LS-ACOs ($501 vs. −$108, p < .001); however, HS-ACOs had a lower quality of care performance (48.79 vs. 53.29, p = .002). Specifically, LS-ACOs had better quality performance than HS-ACOs in patient experience/satisfaction ( p = .02), preventive care services ( p = .004), and hospitalization management ( p = .001), whereas HS-ACOs better performed in routine checkup/follow-up ( p < .001) and risk population management ( p = .048). Our findings indicated that Medicare ACO rewarding model seems to be advantageous for HS-ACOs regardless of the overall quality of care performance.