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In its first year, the Medicare Pioneer accountable care organization (ACO) program resulted in modest reductions in low-value medical services that provide minimal clinical benefit to patients, according to a study published Sept. 21 in JAMA Internal Medicine (doi:10.1001/jamainternmed.2015.4525).
The Pioneer ACO model was associated with a differential reduction of 0.8 in low-value services per 100 beneficiaries or a 1.9% decrease in service quantity, and a 4.5% reduction in spending on low-value services.
Lead author Aaron L. Schwartz, Ph.D., of Harvard Medical School, Boston, and his colleagues compared the use of low-value services by Medicare fee-for-service patients whose providers were in the Pioneer ACO program with use of low-value services by beneficiaries of other health care providers. They examined services from 2009 to 2012 using Medicare claims for a random 20% sample of patients. Comparisons were adjusted for sociodemographic and clinical characteristics and for geography. Low-value services were defined as care providing minimal or no average clinical benefit in specific clinical scenarios.
The greatest reductions in service occurred for the most frequent services, including cancer screening and imaging. Cardiovascular testing and procedures underwent the greatest differential reduction – a 6.3% decrease in low-value services for the Pioneer ACO group. ACOs that were providing more low-value care on average experienced greater reductions.
The study findings are consistent with other conclusions that Pioneer ACO models improve the overall value of health care provided, Dr. Schwartz noted. The findings also demonstrate that patient care preferences may not be major obstacles to reducing low-value service use.
The Medicare Pioneer ACO program aims to improve value and lower cost through incentives and penalties. Participating organizations receive a bonus or a penalty if overall spending for patients is based on meeting a financial benchmark. Performance on 33 quality measures determines the proportion of savings or losses shared by the ACO. In 2012, 32 health care provider organizations volunteered to participate in the Pioneer ACO program. In 2015, there were 19 participating organizations, according to CMS data.
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The study suggests that some ACOs are capable of slowing health care spending growth without jeopardizing the quality of care.
Participants in the first year of the Medicare Pioneer ACO program precisely targeted reduction of low-value services. All doctors increasingly will be called on to apply similar precision in lowering the cost of delivering valuable services without impairing the quality of care. Individually targeted Medicare payment incentives to improve value will begin for physicians in 2019 via a merit-based incentive payment system. One basis for determining individual physician merit will be prudent use of health care resources.
Although adjusting practice to lower costs is a long stretch from physicians’ traditional role, the well-being of their patients and their communities now depend on it.
Dr. Arnold Milstein of the Standford (Calif.) Clinical Excellence Research Center made these comments in an accompanying editorial (doi:10.1001/jamainternmed.2015.5322). He reported no disclosures.
The study suggests that some ACOs are capable of slowing health care spending growth without jeopardizing the quality of care.
Participants in the first year of the Medicare Pioneer ACO program precisely targeted reduction of low-value services. All doctors increasingly will be called on to apply similar precision in lowering the cost of delivering valuable services without impairing the quality of care. Individually targeted Medicare payment incentives to improve value will begin for physicians in 2019 via a merit-based incentive payment system. One basis for determining individual physician merit will be prudent use of health care resources.
Although adjusting practice to lower costs is a long stretch from physicians’ traditional role, the well-being of their patients and their communities now depend on it.
Dr. Arnold Milstein of the Standford (Calif.) Clinical Excellence Research Center made these comments in an accompanying editorial (doi:10.1001/jamainternmed.2015.5322). He reported no disclosures.
The study suggests that some ACOs are capable of slowing health care spending growth without jeopardizing the quality of care.
Participants in the first year of the Medicare Pioneer ACO program precisely targeted reduction of low-value services. All doctors increasingly will be called on to apply similar precision in lowering the cost of delivering valuable services without impairing the quality of care. Individually targeted Medicare payment incentives to improve value will begin for physicians in 2019 via a merit-based incentive payment system. One basis for determining individual physician merit will be prudent use of health care resources.
Although adjusting practice to lower costs is a long stretch from physicians’ traditional role, the well-being of their patients and their communities now depend on it.
Dr. Arnold Milstein of the Standford (Calif.) Clinical Excellence Research Center made these comments in an accompanying editorial (doi:10.1001/jamainternmed.2015.5322). He reported no disclosures.
In its first year, the Medicare Pioneer accountable care organization (ACO) program resulted in modest reductions in low-value medical services that provide minimal clinical benefit to patients, according to a study published Sept. 21 in JAMA Internal Medicine (doi:10.1001/jamainternmed.2015.4525).
The Pioneer ACO model was associated with a differential reduction of 0.8 in low-value services per 100 beneficiaries or a 1.9% decrease in service quantity, and a 4.5% reduction in spending on low-value services.
Lead author Aaron L. Schwartz, Ph.D., of Harvard Medical School, Boston, and his colleagues compared the use of low-value services by Medicare fee-for-service patients whose providers were in the Pioneer ACO program with use of low-value services by beneficiaries of other health care providers. They examined services from 2009 to 2012 using Medicare claims for a random 20% sample of patients. Comparisons were adjusted for sociodemographic and clinical characteristics and for geography. Low-value services were defined as care providing minimal or no average clinical benefit in specific clinical scenarios.
The greatest reductions in service occurred for the most frequent services, including cancer screening and imaging. Cardiovascular testing and procedures underwent the greatest differential reduction – a 6.3% decrease in low-value services for the Pioneer ACO group. ACOs that were providing more low-value care on average experienced greater reductions.
The study findings are consistent with other conclusions that Pioneer ACO models improve the overall value of health care provided, Dr. Schwartz noted. The findings also demonstrate that patient care preferences may not be major obstacles to reducing low-value service use.
The Medicare Pioneer ACO program aims to improve value and lower cost through incentives and penalties. Participating organizations receive a bonus or a penalty if overall spending for patients is based on meeting a financial benchmark. Performance on 33 quality measures determines the proportion of savings or losses shared by the ACO. In 2012, 32 health care provider organizations volunteered to participate in the Pioneer ACO program. In 2015, there were 19 participating organizations, according to CMS data.
On Twitter @legal_med
In its first year, the Medicare Pioneer accountable care organization (ACO) program resulted in modest reductions in low-value medical services that provide minimal clinical benefit to patients, according to a study published Sept. 21 in JAMA Internal Medicine (doi:10.1001/jamainternmed.2015.4525).
The Pioneer ACO model was associated with a differential reduction of 0.8 in low-value services per 100 beneficiaries or a 1.9% decrease in service quantity, and a 4.5% reduction in spending on low-value services.
Lead author Aaron L. Schwartz, Ph.D., of Harvard Medical School, Boston, and his colleagues compared the use of low-value services by Medicare fee-for-service patients whose providers were in the Pioneer ACO program with use of low-value services by beneficiaries of other health care providers. They examined services from 2009 to 2012 using Medicare claims for a random 20% sample of patients. Comparisons were adjusted for sociodemographic and clinical characteristics and for geography. Low-value services were defined as care providing minimal or no average clinical benefit in specific clinical scenarios.
The greatest reductions in service occurred for the most frequent services, including cancer screening and imaging. Cardiovascular testing and procedures underwent the greatest differential reduction – a 6.3% decrease in low-value services for the Pioneer ACO group. ACOs that were providing more low-value care on average experienced greater reductions.
The study findings are consistent with other conclusions that Pioneer ACO models improve the overall value of health care provided, Dr. Schwartz noted. The findings also demonstrate that patient care preferences may not be major obstacles to reducing low-value service use.
The Medicare Pioneer ACO program aims to improve value and lower cost through incentives and penalties. Participating organizations receive a bonus or a penalty if overall spending for patients is based on meeting a financial benchmark. Performance on 33 quality measures determines the proportion of savings or losses shared by the ACO. In 2012, 32 health care provider organizations volunteered to participate in the Pioneer ACO program. In 2015, there were 19 participating organizations, according to CMS data.
On Twitter @legal_med
FROM JAMA INTERNAL MEDICINE
Key clinical point: The Medicare Pioneer ACO program was associated with modest reductions in low-value services that provide minimal clinical benefit to patients.
Major finding: In its first year, the Medicare Pioneer ACO program was associated with a 0.8 reduction in low-value services per 100 beneficiaries, which was a 1.9% reduction in service quantity and a 4.5% reduction in spending on low-value services.
Data source: Random sample of Medicare claims from the period of 2009-2012.
Disclosures: Dr. Aaron L. Schwartz and Dr. J. Michael McWilliams consult for the Medicare Payment Advisory Commission. Dr. Michael E. Chernew is a partner at VBID Health LLC, which has a contract to develop and market a tool to help insurers and employers quantify spending on low-value services.
