Assessing the Effects of Accountable Care Organizations on Surgical Spending and Quality

评估负责任的医疗组织对手术支出和质量的影响

• 批准号: 9237741
• 负责人: John Malcolm Hollingsworth
• 金额: $ 36.69万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9237741
• 关键词: Assessing; Effects; Accountable; Care; Organizations

PROJECT SUMMARY Surgical spending accounts for 30% of national health spending and is growing more rapidly than spending in other key healthcare sectors. Many hope that payment reforms included in the Patient Protection and Affordable Care Act will help curtail such spending growth. Chief among these reforms were provisions for establishing accountable care organizations (ACOs). By encouraging deeper health system integration and greater financial stewardship, proponents believe that ACOs will enhance care coordination and reduce the use of unnecessary services, ultimately improving quality and lowering health spending. However, the net effects of ACOs on surgical care remain unclear. On the one hand, ACOs incentives may motivate clinicians to consider cheaper alternatives to surgery in pursuit of lower population expenditures. On the other hand, shared saving agreements could have unintended consequences. For example primary care providers (PCPs) with ACO contracts may place too much emphasis on surgeons' costs, ignoring their quality, when making referral decisions. Moreover, economic pressures may lead surgeons, who rely on ACO PCPs for a steady stream of patients, to withhold costly but valuable care. In addition, important contextual factors may moderate ACO effects. For instance, ACOs frequently do not encompass surgeon practices and ambulatory surgery centers, where a growing share of surgical care is delivered. If these surgical providers are weakly connected to the PCP groups accepting collective accountability, ACOs' influence on them may be attenuated. In this context, we propose a study to better understand the impact that ACOs have on surgical care. Our proposal has the following three Specific Aims. To determine the impact that ACOs have on surgical spending and quality. Using the national Medicare population, we will identify eligible beneficiaries aligned with a Medicare ACO and those that are not. We will then compare surgical and overall expenditures among these beneficiaries before and after ACO formation. For beneficiaries who undergo surgery, we will also assess their perioperative outcomes and total episode payments. Aim 2: To evaluate for clinical heterogeneity in ACO effects on surgical care delivery. We will identify subsets of Medicare beneficiaries from Aim 1 with one of six conditions for which surgery is considered a treatment. We will then evaluate for differences in surgical spending on higher, intermediate, and lower value surgical procedures among these beneficiaries before and after ACO formation. Aim 3: To assess how heterogeneity in policy implementation affects surgical care delivery. Using linked data from the National Survey of Accountable Care Organizations and network analytical tools, we will assess how financial risk and organizational structure (including surgeon participation) moderate ACO effectiveness. Findings from our study will be directly relevant to the Agency for Healthcare Research & Quality's Research Priority Area #3, as they will inform decision makers at the Centers for Medicare & Medicaid Services about the effects of new reimbursement mechanisms on health spending.

项目摘要 手术支出占全国医疗支出的30%，而且增长速度快于2010年。 其他关键医疗保健行业。许多人希望，支付改革包括在病人保护和 《平价医疗法案》将有助于遏制这种支出增长。这些改革中最主要的是规定， 建立负责任的护理组织（ACO）。通过鼓励更深入的卫生系统一体化， 更大的财务管理，支持者认为，ACO将加强护理协调，减少 使用不必要的服务，最终提高质量，降低卫生支出。但净 ACO对外科护理的影响尚不清楚。一方面，ACO的激励措施可能会激励临床医生 考虑以更便宜的方式替代手术，以降低人口支出。另一方面，共享 储蓄协议可能会产生意想不到的后果。初级保健提供者（PCP） ACO合同在转诊时可能过于强调外科医生的费用，而忽视其质量 决策此外，经济压力可能会导致外科医生，他们依赖ACO PCP来获得稳定的血流。 病人，拒绝昂贵但有价值的护理。此外，重要的背景因素可能会缓和ACO 方面的影响.例如，ACO通常不包括外科医生实践和门诊手术中心， 手术治疗的比例越来越高如果这些手术提供者与 PCP群体接受集体问责，ACO对他们的影响可能会减弱。在这一背景下， 我们提出了一项研究，以更好地了解ACO对外科护理的影响。我们的提案有 三个具体目标。确定ACO对手术费用和质量的影响。 使用全国医疗保险人群，我们将确定符合医疗保险ACO的合格受益人， 那些不是。然后，我们将比较这些受益人的手术和总体支出， 在ACO形成之后。对于接受手术的受益人，我们还将评估其围手术期 结果和总事件支付。目的2：评价ACO对 外科护理递送。我们将从Aim 1中确定符合以下六个条件之一的Medicare受益人子集 手术被认为是一种治疗方法然后，我们将评估手术费用的差异， ACO前后这些受益人中的高、中、低价值外科手术 阵目的3：评估政策实施的异质性如何影响外科护理服务。 利用全国负责任护理组织调查和网络分析工具的相关数据， 我们将评估财务风险和组织结构（包括外科医生参与）如何调节ACO 有效性我们的研究结果将直接与医疗保健研究机构和 质量的研究优先领域#3，因为他们将告知医疗保险中心的决策者& 医疗补助服务关于新的报销机制对卫生支出的影响。