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Medicare ACOs Face Accountability Challenges

Significant specialty care provided to beneficiaries outside of the assigned ACO

WEDNESDAY, April 23, 2014 (HealthDay News) -- There are significant challenges to achieving organizational accountability in accountable care organizations (ACOs) assigned to Medicare beneficiaries, according to a study published online April 21 in JAMA Internal Medicine.

J. Michael McWilliams, M.D., Ph.D., from Harvard Medical School in Boston, and colleagues examined three constructs pertinent to ACO incentives (stability of patient assignment, leakage of outpatient care, and contract penetration) based on rosters of physicians in organizations participating in ACO programs and Medicare claims (2010 to 2011).

The researchers found that 80.4 percent of the beneficiaries assigned to an ACO in 2010 were assigned to the same ACO in 2011. Beneficiaries with fewer conditions and office visits as well as those with the highest decile of per-beneficiary spending were more commonly associated with unstable assignment. Nearly 9 percent of ACO-assigned beneficiary office visits with primary care physicians were provided outside of the assigned ACO, as were 66.7 percent of office visits with specialists. Higher-cost beneficiaries had greater leakage of outpatient specialty care, which was substantial even among specialty-oriented ACOs. Medicare spending on outpatient care billed by ACO physicians was higher for ACOs with greater primary care orientation.

"Continued monitoring of these patterns may be important to determine the regulatory need for enhancing ACOs' incentives and their ability to improve care efficiency," the authors write.

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