Hofler Richard A, Ortiz Judith
Department of Economics, University of Central Florida, P.O. Box 161400, Orlando, FL, 32816-1400, USA.
College of Health and Public Affairs, University of Central Florida, P.O. Box 162369, Orlando, FL, 32816, USA.
BMC Health Serv Res. 2016 Jul 28;16:315. doi: 10.1186/s12913-016-1556-6.
Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization's costs. The purpose of this study was to determine whether joining an ACO is associated with an increase in a Rural Health Clinic's (RHC's) cost per visit.
The analyses focused on cost per visit in 2012 and 2013 for RHCs that joined an ACO in 2012 and cost per visit in 2013 for RHCs that joined an ACO in 2013. The RHCs were located in nine states. Data were obtained from Medicare Cost Reports. The analysis was conducted taking a treatment effects approach where the treatment is joining an ACO. Propensity-score matching was employed to provide multiple single and pooled estimates of the average treatment effect on the treated.
Four-hundred thirty four to 544 RHCs (depending on the type of analysis and the variables used) were used in the several analyses. Seven of the RHCs joined an ACO in 2012 and 14 joined an ACO in 2013. The mean cost per visit for RHCs that did not join an ACO rose 4.40 % from 2011 to 2012 whereas the mean cost per visit for RHCs that joined an ACO rose by triple: 13.5 %. All of the pooled estimates of the average treatment effect on the treated from the propensity-score matching showed that joining an ACO was associated with higher mean cost per visit. The range of the estimated mean cost per visit differences was $17.19 (p value = 0.00) to $25.19 (p value = 0.00).
This study is one of the first to describe the cost of ACO participation from the perspective of primary care provider organizations. It appears that for at least one type of primary care provider - the RHC - there are substantial costs associated with ACO participation during the first two years.
关于加入责任医疗组织（ACO）对初级医疗服务提供者组织成本的影响，人们了解甚少。本研究的目的是确定加入ACO是否与农村健康诊所（RHC）每次就诊成本的增加相关。
分析聚焦于2012年加入ACO的RHC在2012年和2013年的每次就诊成本，以及2013年加入ACO的RHC在2013年的每次就诊成本。这些RHC分布在九个州。数据来自医疗保险成本报告。分析采用治疗效应方法，其中治疗为加入ACO。采用倾向得分匹配法对治疗组的平均治疗效应进行多个单估计和合并估计。
在几次分析中使用了434至544个RHC（取决于分析类型和所用变量）。其中7个RHC在2012年加入ACO，14个在2013年加入ACO。未加入ACO的RHC每次就诊的平均成本从2011年到2012年上升了4.40%，而加入ACO的RHC每次就诊的平均成本上升了三倍：13.5%。倾向得分匹配法对治疗组平均治疗效应的所有合并估计表明，加入ACO与每次就诊的更高平均成本相关。估计的每次就诊平均成本差异范围为17.19美元（p值 = 0.00）至25.19美元（p值 = 0.00）。
本研究是首批从初级医疗服务提供者组织角度描述参与ACO成本的研究之一。看来，至少对于一种类型的初级医疗服务提供者——RHC——在头两年参与ACO会带来巨大成本。
