Will the Reach of ACOs Extend to Specialty Care?

项目摘要 2010年的《患者保护和平价医疗法案》包括各种支付和提供系统 改革，以遏制医疗支出，其中最显着的是建立医疗保险问责 护理组织（ACOs）。ACO最初的重点是加强初级保健， 有多种慢性病的受益人;然而，有理由相信，ACO可能 有利于其他有改进余地的关键医疗保健部门。专科护理就是这样一个部门， 主要影响ACO的共同储蓄目标，鉴于其利用和支出的广泛差异， 占所有医疗支出的近50%。虽然ACO没有明确针对专业护理，但他们的 强调更深入的临床整合和更大的财务管理可能会从根本上改变 初级保健医生（PCP）之间的专家转诊模式，并对专家的治疗产生影响 当护理价值有疑问时做出决定。然而，ACO对专科护理的影响也可能有限。 大多数医疗保险ACO合同不包括专业实践。尽管这些供应商仍然存在， 与接受共同责任的PCP联系较弱，ACO可能对专科护理影响不大 利用率和成本效率。它们甚至可能产生不正当的激励措施，使结果恶化。在这一背景下， 我们建议进行一项研究，以评估ACO对专科护理服务的影响。我们的提案 三个具体目标。目的1：测量ACO对PCP专家转诊的影响 网络.使用国家医疗保险数据，我们将确定患者的四个示踪条件之一（缺血性 心脏病、下肢关节疼痛和新诊断的乳腺癌或前列腺癌）和提供者 照顾他们的人。我们将区分参加Medicare ACO的团体和 并不是。然后，我们将使用网络分析工具来衡量这些群体中的专家转诊模式， 在ACO形成之后。目的2：评估ACO对专家治疗决策的影响。接下来， 我们将计算高价值和低价值诊断和治疗护理过程的利用率， 目标1中确定的患者队列。我们将比较参与和不参与的这些比率 在ACO形成之前和之后的供应商组。目的3：确定ACO对效率的影响 治疗的过程。最后，我们将确定治疗期间的医疗保险付款 在ACO形成前后。我们将探索潜在的节省资源，包括部分付款 用于医生服务、医院和艾德护理。我们的研究结果将直接关系到该机构 医疗保健研究和质量的研究优先领域#3，因为他们将告知政策制定者在医疗保险 关于ACO对专科护理服务的影响。

PROJECT SUMMARY The Patient Protection and Affordable Care Act of 2010 included a variety of payment and delivery system reforms to curb health spending, the most notable of which was the establishment of Medicare accountable care organizations (ACOs). Much of the initial focus of ACOs has been on enhanced primary care for beneficiaries who have multiple chronic conditions; however, there are reasons to believe that ACOs may benefit other key healthcare sectors where room for improvement exists. Specialty care is one such sector with major implications for ACOs' shared savings goals, given wide variation in its utilization and expenditures that account for nearly 50% of all health spending. While ACOs do not explicitly target specialty care, their emphasis on deeper clinical integration and greater financial stewardship could fundamentally change specialist referral patterns among primary care physicians (PCPs) and have an impact on specialists' treatment decisions when the care is of questionable value. Yet ACOs' impact on specialty care could also be limited. Most Medicare ACO contracts do not encompass specialist practices. Insofar as these providers remain weakly connected to PCPs accepting shared accountability, ACOs may have little influence on specialty care utilization and cost efficiency. They may even create perverse incentives that worsen outcomes. In this context, we propose a study to assess the impact that ACOs have on specialty care delivery. Our proposal has the following three Specific Aims. Aim 1: To measure the effects of ACOs on PCP-specialist referral networks. Using national Medicare data, we will identify patients with one of four tracer conditions (ischemic heart disease, lower extremity joint pain, and newly diagnosed breast or prostate cancer) and the provider groups that care for them. We will distinguish between groups participating in a Medicare ACO and those that are not. We will then use network analytical tools to measure specialist referral patterns in these groups before and after ACO formation. Aim 2: To assess the effects of ACOs on specialists' treatment decisions. Next, we will calculate utilization rates of high- and low-value diagnostic and therapeutic care processes across the patient cohorts identified in Aim 1. We will compare these rates among participating and non-participating provider groups before and after ACO formation. Aim 3: To determine the effects of ACOs on the efficiency of the treatment episode. Finally, we will determine Medicare payments made during treatment episodes before and after ACO formation. We will explore potential sources of savings, including component payments for physician services and hospital and ED care. Findings from our study will be directly relevant to the Agency for Healthcare Research & Quality's Research Priority Area #3, as they will inform policymakers at Medicare about the effects of ACOs on specialty care delivery.