Douven Rudy, McGuire Thomas G, McWilliams J Michael
Rudy Douven (
Thomas G. McGuire is a professor of health economics at Harvard Medical School, in Boston, Massachusetts.
Health Aff (Millwood). 2015 Jan;34(1):143-9. doi: 10.1377/hlthaff.2014.0444.
One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers.
医疗保险责任医疗组织(ACO)共享节约计划的一个目标是,相对于这些组织的支出历史,减少为ACO患者的医疗保险支出。然而,我们发现,目前设定ACO支出目标(或基准)的规则削弱了ACO产生节约的激励,甚至可能鼓励医疗保险支出增加而非减少。在ACO签订或续签合同前的三年支出,在基准计算中的权重并不相同,新合同开始前一年的权重高达0.6。因此,ACO有动机在那一年增加支出,以抬高其未来几年的基准,从而在新合同期内更容易从医疗保险中获得共享节约。我们提出了改善对ACO激励的策略,包括改变用于确定基准的权重以及新的支付模式,即ACO的支出目标不仅基于其自身过去的表现,还基于其他ACO或医疗保险提供者的表现。