Rose Sherri, Zaslavsky Alan M, McWilliams J Michael
Sherri Rose is an assistant professor of health care policy (biostatistics) in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
Alan M. Zaslavsky is a professor of health care policy (statistics) in the Department of Health Care Policy at Harvard Medical School.
Health Aff (Millwood). 2016 Mar;35(3):440-8. doi: 10.1377/hlthaff.2015.1026.
Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.
参与医疗保险共同储蓄计划的 accountable care organizations（ACOs）的支出目标（或基准）必须谨慎设定，以鼓励参与该计划，同时实现财政目标并尽量减少意外后果，例如因服务病情较重的患者而惩罚 ACOs。最近提议的监管变化包括采取措施，使同一地区不同历史支出水平的 ACOs 的基准更加相似。我们发现，在进行标准病例组合调整后，ACOs 的支出水平与其他当地医疗服务提供者的支出水平相比差异很大。此外，根据患者健康状况的调查指标进行调整，显著降低了 ACO 支出与当地平均按服务收费支出之间差异的变化，但仍存在很大差异，这表明 ACOs 与当地非 ACO 医疗服务提供者之间的护理效率差异很大。因此，应逐步实施平衡高支出和低支出 ACOs 之间基准的措施，例如将基准设定为某个地区经风险调整后的平均按服务收费支出，以维持高支出 ACOs 的参与度。使用调查信息也有助于减轻风险选择和编码上调的不良激励，并限制新基准方法对服务病情较重患者的 ACOs 产生的意外后果。
