Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Health Serv Res. 2013 Aug;48(4):1526-38. doi: 10.1111/1475-6773.12032. Epub 2013 Jan 27.
To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs).
Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Association Group Practice data identifying provider groups sufficiently large to be eligible for ACO program participation.
We calculated the fraction of community-dwelling beneficiaries whose assignment shifted, as a consequence of including post-acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post-acute care.
Assignment shifts occurred for 27.6 percent of 25,992 community-dwelling beneficiaries with at least one post-acute skilled nursing facility stay, and they were more common for those incurring higher Medicare spending. Those whose assignment shifted constituted only 1.3 percent of all community-dwelling beneficiaries cared for by large ACO-eligible organizations (n = 535,138), but they accounted for 8.4 percent of total Medicare spending for this population.
Under current Medicare assignment rules, ACOs may not be accountable for an influential group of post-acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions.
确定将急性后期评估和管理（E&M）服务作为初级保健服务纳入后，对医疗保险受益人的医疗服务提供方的分配方式的影响。
将 2009 年随机抽取的 5%的医疗保险受益人的医疗保险索赔与美国医学协会的团体实践数据相关联，这些数据确定了足够大的服务提供商群体，使其有资格参加 ACO 计划。
我们计算了由于包括急性后期 E&M 服务，其门诊初级保健服务的提供者群体发生变化的、居住在社区的受益人的比例，转移到提供其住院急性后期护理的不同群体。
在至少有一次急性后期熟练护理设施住院的 25992 名居住在社区的受益人中，有 27.6%的人发生了分配转移，对于那些医疗支出较高的人来说，这种转移更为常见。那些发生分配转移的人仅占由大型 ACO 合格组织（n=535138）照顾的所有居住在社区的受益人的 1.3%，但他们占该人群总医疗保险支出的 8.4%。
根据当前的医疗保险分配规则，ACO 可能无法对有影响力的急性后期患者群体负责，这表明在改善护理协调和减少不必要的再入院方面存在错失的机会。
