小型医疗机构在医疗保险责任制医疗组织中的参与度和表现。

Small practice participation and performance in Medicare accountable care organizations.

机构信息

University of Michigan, 2800 Plymouth Rd, NCRC B16, Ann Arbor, MI 48109. Email:

出版信息

Am J Manag Care. 2022 Mar;28(3):117-123. doi: 10.37765/ajmc.2022.88839.

DOI:10.37765/ajmc.2022.88839

PMID:35404547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11791871/

Abstract

OBJECTIVES

Alternative payment models (APMs) encouraging provider collaboration may help small practices overcome the participation challenges that they face in APMs. We aimed to determine whether small practices in accountable care organizations (ACOs) reduced their beneficiaries' spending more than large practices in ACOs.

STUDY DESIGN

Retrospective cohort study of Medicare patients attributed to ACOs and non-ACOs.

METHODS

We conducted a modified difference-in-differences analysis that allowed us to compare large vs small practices before and after the Medicare Shared Savings Program (MSSP) ACO started, between 2010 and 2016. Our sample included Medicare fee-for-service beneficiaries with 12 months of Medicare Part A and Part B (unless death) who were attributed to small (≤ 15 providers) and large (> 15 providers) practices participating in ACOs and non-ACOs. The outcome was patient annual spending based on CMS' total per capita costs.

RESULTS

Patients attributed to small practices in ACOs had annual Medicare spending decreases of $269 (95% CI, $213-$325; P < .001) more than patients attributed to large practices in ACOs. Small ACO practices reduced spending more than large practices by $165 for physician services (95% CI, $140-$190; P < .001), $113 for hospital/acute care (95% CI, $65-162; P < .001), and $52 for other services (95% CI, $27-$77; P < .001). Small practices in ACOs spent $253 more on average at baseline than small practices in non-ACOs. ACOs with a higher proportion of small practices were more likely to receive shared savings payments.

CONCLUSIONS

Small practices in ACOs controlled costs more so than large practices. Small practice participation may generate higher savings for ACOs.

摘要

目的

鼓励提供者合作的替代支付模式（APM）可能有助于小型实践克服他们在 APM 中面临的参与挑战。我们的目的是确定在问责制医疗组织（ACO）中的小型实践是否比 ACO 中的大型实践更能降低其受益人的支出。

研究设计

对归因于 ACO 和非 ACO 的 Medicare 患者进行回顾性队列研究。

方法

我们进行了修正的差异中的差异分析，使我们能够在 2010 年至 2016 年期间比较 Medicare 共享储蓄计划（MSSP）ACO 开始前后大型与小型实践之间的差异。我们的样本包括具有 12 个月 Medicare 第 A 部分和第 B 部分（除非死亡）的 Medicare 收费服务受益人，他们归因于参与 ACO 和非 ACO 的小型（≤15 名提供者）和大型（>15 名提供者）实践。结果是基于 CMS 总人均成本的患者年度支出。

结果

归因于 ACO 中的小型实践的患者每年 Medicare 支出减少了 269 美元（95%CI，213-325 美元；P<.001），比归因于 ACO 中的大型实践的患者多。与大型实践相比，小型 ACO 实践在医生服务方面减少了 165 美元（95%CI，140-190 美元；P<.001），在医院/急性护理方面减少了 113 美元（95%CI，65-162 美元；P<.001），在其他服务方面减少了 52 美元（95%CI，27-77 美元；P<.001）。ACO 中的小型实践的基线平均支出高出 253 美元。小型实践比例较高的 ACO 更有可能获得共享储蓄支付。