Accountable care organizations and the diffusion of new surgical procedures

 描述（由申请人提供）：新技术的开发和传播是医疗保险支出增长的主要决定因素。新的生物制剂、成像检测和设备是在卫生支出中发挥不成比例作用的许多新技术部门。然而，技术支出增长的一个重要贡献者，往往被低估，是新外科手术的传播。长期以来，阻止低价值技术的传播一直是支付者和政策制定者的优先事项。许多人希望负责任的护理组织（ACO）能做到这一点。先锋和医疗保险共享储蓄计划ACOs的一项根本性改革是将医生、医院和其他护理人员团结在一个实体之下，以提供更综合的护理。此外，ACO意味着与传统的偿还方式相比有很大的变化，最初涉及适度的财务风险，但最终在某些情况下导致部分资本化付款。更好地了解ACO对使用新外科手术的影响对于预测卫生改革对技术传播和成本控制的更广泛影响至关重要。为了更仔细地研究这一问题，本建议有三个目标。目的1：评估ACO对手术技术替代现有疗法的影响。利用国家医疗保险数据，我们将确定卫生系统如何用新程序取代旧程序，特别关注根据其价值在不同技术之间产生的影响的异质性。目的2：测量ACO对手术技术相关治疗扩展的影响。使用类似的方法，我们将评估卫生系统扩大治疗人群的程度，重点关注手术中患者之间效果的异质性。目的3：确定不断升级的财务激励措施对选择ACO使用手术技术的影响。我们会在部分资本化付款开始之前和之后，评估程序的使用情况。更好地了解ACO对手术技术扩散的潜在影响，是预测未来医疗保险支出增长的关键。这一提议对支付者和政策制定者具有真实的世界影响，因为他们正在努力设计有效的政策来提高交付系统的效率。

 DESCRIPTION (provided by applicant): The development and dissemination of new technology is a major determinant of growth in Medicare spending. New biological agents, imaging tests, and devices are among the many sectors of new technology that play a disproportionate role in health expenditures. However, an important contributor to growth in technology spending, and oft underappreciated, is the dissemination of new surgical procedures. Discouraging the dissemination of low value technologies has long been a priority for payers and policymakers. Many hope that accountable care organizations (ACOs) will do just that. A fundamental reform of both Pioneer and Medicare Shared Savings Program ACOs is to unite physicians, hospitals and other caregivers under a single entity to provide more integrated care. Additionally, ACOs imply a considerable change from traditional reimbursement, involving modest financial risk initially, but ultimately resulting in partially capitated payments in some cases. A better understanding of the effects of ACOs on the use of new surgical procedures would be important for anticipating the broader implications of health reform for technology diffusion and cost containment. To examine this issue more carefully, this proposal has three aims. Aim 1: To assess the impact of ACOs on the substitution of surgical technologies for existing therapies. Using national Medicare data, we will determine how health systems substitute new procedures for old ones, focusing in particular on the heterogeneity in effects across technologies according to their value. Aim 2: To measure the impact of ACOs on treatment expansion associated with surgical technologies. Using similar methods, we will assess the extent to which health systems expand the population treated, focusing on the heterogeneity in effects across patients within a procedure. Aim 3: To determine the effect of escalating financial incentives to select ACOs on the use of surgical technologies. We will assess the use of procedures before and after the commencement of partially capitated payments to select ACOs. An improved understanding of the potential impact of ACOs on surgical technology diffusion is central to anticipating future Medicare spending growth. This proposal has real world implications for payers and policymakers as they struggle with designing effective policies to improve the efficiency of the delivery system.