Margolis Center for Health Policy, Duke University, 230 Science Dr, Durham, NC 27705. Email:
Am J Manag Care. 2020 Dec;26(12):534-540. doi: 10.37765/ajmc.2020.88541.
Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and retrospective ACO populations.
This retrospective, cross-sectional analysis describes survival, patient characteristics, and Medicare spending for Medicare fee-for-service beneficiaries identified with serious illness (n = 1,600,629) using 100% Medicare Master Beneficiary Summary and MSSP beneficiary files (2014-2016).
We used generalized linear models with ACO and year fixed effects to estimate the average within-ACO difference between potential retrospective and prospective ACO populations.
Dying in the first 90 days of the performance year was associated with reduced odds of retrospective ACO attribution (odds ratio [OR], 0.24; 95% CI, 0.24-0.25) relative to beneficiaries surviving 270 days or longer. Similarly, hospice use was associated with reduced odds of retrospective assignment (OR, 0.80; 95% CI, 0.79-0.80). Among ACOs that did not achieve shared savings, average per capita Medicare expenditures (after truncation) were $2459 (95% CI, $2192-$2725) higher for prospective vs retrospective ACO populations. The difference was $834 (95% CI, $402-$1266) greater per capita among ACOs that achieved shared savings.
The difference in survival and spending for ACO populations captured by prospective vs retrospective attribution methods means that ACOs may need to employ different care management strategies to improve performance depending on their attribution method.
自 2019 年以来，医疗保险共享储蓄计划（MSSP）允许责任医疗组织（ACO）选择回顾性或前瞻性归因 ACO 人群。为了了解 ACO 归因方法的选择如何影响重病医疗保险受益人的护理激励措施，本研究比较了前瞻性和回顾性 ACO 人群的受益人的特征和医疗保险人均支出。
本回顾性、横断面分析描述了使用 100%医疗保险主受益人和 MSSP 受益人的文件（2014-2016 年）确定患有重病（n=1,600,629）的医疗保险费用受益人的生存情况、患者特征和医疗保险支出。
我们使用具有 ACO 和年份固定效应的广义线性模型，来估计潜在的回顾性和前瞻性 ACO 人群之间的平均 ACO 内差异。
在绩效年内的头 90 天内死亡与回顾性 ACO 归因的可能性降低相关（优势比[OR]，0.24；95%CI，0.24-0.25），与存活 270 天或更长时间的受益人相比。同样，临终关怀的使用与回顾性分配的可能性降低相关（OR，0.80；95%CI，0.79-0.80）。在未实现共享储蓄的 ACO 中，前瞻性 ACO 人群的人均医疗保险支出（截尾后）平均高出 2459 美元（95%CI，2192-2725 美元）。在实现共享储蓄的 ACO 中，人均高出 834 美元（95%CI，402-1266 美元）。
前瞻性和回顾性归因方法捕获的 ACO 人群的生存和支出差异意味着 ACO 可能需要根据其归因方法采用不同的护理管理策略来提高绩效。
