Data on Medicare Shared-Savings ACOs Mixed After First Year
New data shows that, although accountable care organizations (ACOs) who entered the Medicare Shared Savings Program (MSSP) in 2012 had significant reductions in spending after the first full year in the program, ACOs that entered in 2013 did not.
In the study, published in the New England Journal of Medicine, spending and performance data from Medicare claims for beneficiaries between 2008 and 2013 from 220 ACOs entering the MSSP in 2012 or 2013 were compared with those from non-ACO providers on claims-based quality measures.
ACOs that joined in 2012 had a spending reduction of $238 million (1.4%). Mean total annual Medicare spending was $144 less per beneficiary compared with that of non-ACOs (P = .02). In contrast, ACOs that joined in 2013 had a savings of only $3 per beneficiary compared with non-ACOs (P = .96).
Contributing to the savings on 2012 were reductions in spending on inpatient care (1.4%); hospital outpatient care (2.1%, although this was mostly offset by a 1.5% increase in spending on office-based outpatient care); post-acute care at skilled nursing facilities (6.1%); and home health care (2.7%). Despite these reductions in spending, however, net savings to Medicare were not achieved because Medicare had to pay out $244 million in shared-savings bonuses.
Among both cohorts, estimated savings were significantly greater for independent primary care groups than for groups integrated with hospitals. “Independent physician groups have stronger incentives to lower inpatient and hospital outpatient spending than groups integrated with hospitals because their shared-savings bonuses are not offset by forgone profits from reductions in hospital care,” the authors suggested.
The authors concluded that their findings suggest progress toward net savings to Medicare as a result of implementing ACO programs may be slow.—FRMC Editor
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