Cancer spending and accountable care organizations: Evidence from the Physician Group Practice Demonstration
Cancer spending and accountable care organizations: Evidence from the Physician Group Practice Demonstration
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DOI：
10.1016/j.hjdsi.2013.05.005
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发表时间：
2013-12-01
影响因子：
2.5
通讯作者：
Fisher, Elliott S.
中科院分区：
文献类型：
--
作者：
Colla, Carrie H.;Lewis, Valerie A.;Fisher, Elliott S.
背景资料：尽管责任医疗组织（ACO）正在迅速部署在医疗保险中，但人们对这种模式如何影响癌症患者等高风险、高成本群体知之甚少。2005年至2010年在10个医生团体中进行的医生团体实践示范，提供了目前最好的证据，证明了医疗保险受益人的负责任医疗组织的可能有效性。癌症治疗和支出的变化可能是根据ACO支付改革癌症治疗的指示。方法：使用医疗保险按服务收费索赔数据，回归分析被用来估计癌症患者支付的变化，使用差异中的差异设计，（2001-2004年）和干预后（2005-2009年）PGPD参与者与当地对照组在癌症患者上的支出趋势。回归模型表明，医生小组实践示范与参与站点中每位癌症患者每年721美元的平均医疗保险支出减少有关，每名患者的费用每年减少3.9%。节省的费用完全来自减少住院病人的急性护理费用。该示范还与癌症患者死亡率的降低有关。在医院发生的死亡比例没有显著变化。临终关怀的使用，出院和ICU天数显着减少，但癌症特异性程序或化疗没有减少。所有措施的估计差异很大，在participating sites.Conclusions：医生组的做法示范是与住院治疗的受益人与流行的癌症之间的减少，对死亡率没有不利影响。参与医师小组实践演示的参与者并没有改变癌症特异性治疗的支出轨迹。含义：癌症受益人的住院治疗可能是AC 0潜在节省的重要来源，但医师小组实践示范的证据表明，癌症治疗（如化疗或手术）没有改变。(C)2013爱思唯尔公司All rights reserved.
Background: Although accountable care organizations (ACOs) are rapidly being deployed in Medicare, little is known about how the model might affect high-risk, high cost groups such as cancer patients. The Physician Group Practice Demonstration, which ran from 2005 to 2010 in 10 physician groups, provides the best current evidence on the likely effectiveness of accountable care organizations for Medicare beneficiaries. Changes in cancer treatment and spending under this program may be indicative of cancer treatment under ACO payment reform.Methods: Using Medicare fee-for-service claims data, regression analysis was used to estimate changes in payments for cancer patients using a difference-in-difference design comparing pre- (2001-2004) and post-intervention (2005-2009) trends in spending on cancer patients in PGPD participants to local control groups.Results: Regression models indicate the Physician Group Practice Demonstration was associated with average Medicare spending reductions per cancer patient of $721 annually across participating sites, an annual 3.9% reduction in payments per patient. Savings derived entirely from reductions in acute care payments for inpatient stays. The Demonstration was also associated with a reduction in mortality among cancer patients. There was no significant change in the proportion of deaths occurring in the hospital. There were significant reductions in hospice use, hospital discharges and ICU days, but no reductions in cancer-specific procedures or chemotherapy. Estimates of all measures varied considerably across participating sites.Conclusions: The Physician Group Practice Demonstration was associated with reductions in admissions for inpatient care among beneficiaries with prevalent cancer, with no adverse effect on mortality. Participants in the Physician Group Practice Demonstration did not change the trajectory of spending for cancer-specific treatments. Implications: Inpatient care for beneficiaries with cancer may represent a significant source of potential savings for AC0s, but evidence from the Physician Group Practice Demonstration indicates that no changes were made to cancer treatments such as chemotherapy or surgical procedures. (C) 2013 Elsevier Inc. All rights reserved.