Medicare system seeks to improve the care of older adults while also keeping costs from growing too fast, a new University of Michigan study suggests that one major effort may not be having as much of an impact as hoped. A new analysis of data from the Medicare Shared Savings Program finds that high-cost physicians and high-cost patients dropping out of the program accounted for much of the savings report from 2008 to 2014.
The Medicare system
After the effects of those departures were take into account; so the Accountable Care Organizations taking part in the MSSP had the same costs; so as physicians in their area who weren’t taking part in ACOs; but also took care of other patients with traditional Medicare coverage. The study also compares ACO and non-ACO providers on measures of health care quality, finding that patients in an MSSP ACO were not more likely to get four proven tests for common health problems than similar patients with the same kind of Medicare coverage who weren’t part of an ACO.
ACOs can earn extra dollars from Medicare base on their overall costs and quality average across all their providers’ patients, or can lose money if they don’t meet cost or quality goals. The Centers for Medicare and Medicaid Services has set a goal of increasing the disincentives or “risk” that ACOs face, so accurate measurement of actual cost and quality performance will increase in importance, the researchers say.
At the project’s outset, we hypothesized that early savings in this voluntary ACO program were driven by disproportionate entry of high-performing early adopter clinicians into ACOs, Markovitz said. To our surprise, we find that ACO savings may be driven by the disproportionate exit of higher-spending clinicians out of ACOs.
The Health Affairs
Markovitz, Ryan and colleagues publish a study in Health Affairs earlier this year; so showing that high-cost patients were slightly more likely to leave ACOs than lower-cost ones. They note in that study that the MSSP program does not adjust ACOs’ payments; so depending on how much more ill their participating patients have become over time; the payment is base on how sick each patient was when their provider first join the ACO.
That study, and the new study, have implications for the changes; so being propose for MSSP and other value base payment programs in Medicare. There need to be more safeguards against the selective attrition of patients; also providers from ACOs that they’ve observe in our studies,” Ryan said. “As CMS encourages more provider risk-taking; so it should design its systems to support what’s working best to improve care and efficiency.”
Markovitz also notes that CMS could design more future Medicare; so innovations as true experiments; for instance, with randomization or a phase roll-out that allows researchers to evaluate more readily; so whether a program truly save money or improve quality. In addition to Markovitz and Ryan, the study’s authors are John Hollingsworth, John Ayanian, Edward Norton and Phyllis Yan. Ayanian directs, and Hollingsworth, Norton and Ryan are members of the U M Institute for Healthcare Policy and Innovation.