The Impact of Accountable Care Organizations on Post Acute Care

项目摘要 问责医疗组织（ACO），在2012年医疗保险批准后引入， 2010年《平价医疗法案》是自2010年以来最重要的医疗保险支付政策改革之一。 30年前就引入了预期付款。ACO迅速增长，截至2015年4月， 覆盖了约800万（15%）医疗保险按服务收费（FFS）受益人。CMS计划 在未来三年继续积极发展。ACO是由医生、医院和其他 医疗保健提供者，他们共同负责为FFS Medicare的特定群体提供护理 受益人。ACO支付模式通过为提供商提供任何节省的份额来激励价值， 只要它们符合一定的质量标准，就可以相对于支出基准实现。迄今为止 ACO成功的现有证据集中在他们的财务业绩和一些病人 结果测量，包括可能避免的住院和再住院。不过有 没有证据表明ACO如何影响急性期后护理（PAC），这是ACO中增长最快的组成部分之一。 医疗保险支出，并在医学研究所的一份报告中确定为医疗保险的主要驱动力 支出变化。此外，当前的ACO质量基准添加了一个PAC质量度量 2015年（专业护理机构再住院）。本提案的目的是研究ACO的影响 PAC的使用和结果的增长; ACO对PAC使用和非ACO结果的溢出效应。 ACO FFS受益人在同一个市场;并确定ACO和PAC供应商的战略， 医疗保险支出的更大价值减少以及质量改善。拟定的研究将 链接2009-2016年ACO参与数据、Medicare索赔数据和SNF、IRF和HHA评估数据 进行差异中的差异人级匹配分析，检查ACO对 PAC通过追求以下具体目标：1。检查PAC目的地在一个事件中的变化 与受益人ACO参与相关的护理。2.确定ACO参与对PAC的影响 质量和成果。3.确定是否有两个具体的行政协调办公室实施的PAC战略，集中和 替代，与更好的结果和更低的支出有关;以及这些策略如何随关键ACO而变化 结构特征这项研究的预期结果是有史以来第一次全国性的证据， ACO改善了PAC值。这项研究将提供全面的资料，以指导政策决定 随着医疗保险继续修改ACO计划以激励价值。

PROJECT SUMMARY Accountable Care Organizations (ACOs), introduced in Medicare in 2012 following the approval of the 2010 Affordable Care Act, represent one of the most important Medicare payment policy reforms since prospective payment was introduced thirty years ago. ACOs have rapidly grown and as of April 2015 they covered approximately 8 million (15%) Medicare fee-for-service (FFS) beneficiaries. CMS has plans for continued aggressive growth over the next three years. ACOs are groups of doctors, hospitals, and other health care providers, who share responsibility for providing care to a defined group of FFS Medicare beneficiaries. The ACO payment model incentivizes value by offering providers a share of any savings they achieve relative to a spending benchmark as long as they meet certain quality standards. To date, the available evidence of the success of ACOs has focused on their financial performance and on some patient outcome measures, including potentially avoidable hospitalizations and rehospitalizations. However, there is no evidence of how ACO has impacted post-acute care (PAC), one of the fastest growing components of Medicare spending and identified in an Institute of Medicine report as the dominant driver of Medicare spending variation. Furthermore, current ACO quality benchmarks have a single PAC quality measure added in 2015 (skilled nursing facility rehospitalizations). The goal of this proposal is to study the impact of ACO growth on the use and outcomes of PAC; the spill-over effects of ACOs on the PAC use and outcomes of non- ACO FFS beneficiaries in the same market; and to identify ACO and PAC provider strategies associated with greater value—reductions in Medicare spending together with quality improvements. The proposed study will link ACO participation data, Medicare claims data and SNF, IRF and HHA assessment data across 2009-2016 to conduct a difference-in-differences person-level matched analysis that examines the impact of ACOs on PAC by pursuing the following specific aims: 1. Examine changes in PAC destinations across an episode of care associated with beneficiary ACO participation. 2. Determine the impact of ACO participation on PAC quality and outcomes. 3. Determine whether two specific ACO-implemented PAC strategies, concentration and substitution, are linked to better outcomes and lower spending; and how these strategies vary with key ACO structural characteristics. The expected outcome of this research is the first-ever national evidence of whether ACOs have improved PAC value. This study will provide comprehensive information to guide policy decisions as Medicare continues to modify ACO initiatives to incentivize value.