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Post‐Acute Care and ACOs — Who Will Be Accountable?
Author(s) -
McWilliams J. Michael,
Chernew Michael E.,
Zaslavsky Alan M.,
Landon Bruce E.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12032
Subject(s) - acute care , medicine , random assignment , family medicine , inclusion (mineral) , population , primary care , managed care , nursing , emergency medicine , health care , environmental health , psychology , social psychology , pathology , economics , economic growth
Objective To determine how the inclusion of post‐acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations ( ACO s). Data Sources Medicare claims for a random 5 percent sample of 2009 M edicare beneficiaries linked to A merican M edical A ssociation G roup P ractice data identifying provider groups sufficiently large to be eligible for ACO program participation. Study Design We calculated the fraction of community‐dwelling beneficiaries whose assignment shifted, as a consequence of including post‐acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post‐acute care. Principal Findings Assignment shifts occurred for 27.6 percent of 25,992 community‐dwelling beneficiaries with at least one post‐acute skilled nursing facility stay, and they were more common for those incurring higher M edicare spending. Those whose assignment shifted constituted only 1.3 percent of all community‐dwelling beneficiaries cared for by large ACO ‐eligible organizations ( n = 535,138), but they accounted for 8.4 percent of total M edicare spending for this population. Conclusions Under current M edicare assignment rules, ACO s may not be accountable for an influential group of post‐acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions.