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.

项目概要 手术支出占全国卫生支出的30%，且增长速度快于医疗支出 其他关键医疗保健部门。许多人希望将支付改革纳入患者保护和 《平价医疗法案》将有助于抑制此类支出增长。这些改革中最主要的是规定： 建立责任护理组织 (ACO)。通过鼓励更深入的卫生系统整合和 加强财务管理，支持者认为 ACO 将加强护理协调并减少 使用不必要的服务，最终提高质量并降低医疗支出。然而，网 ACO 对手术护理的影响仍不清楚。一方面，ACO 的激励措施可能会激励临床医生 考虑采用更便宜的手术替代方案，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。例如初级保健提供者 (PCP) 在转诊时，ACO 合同可能过于强调外科医生的成本，而忽视了他们的质量 决定。此外，经济压力可能会导致外科医生依赖 ACO PCP 获得稳定的医疗资源 患者，拒绝接受昂贵但有价值的护理。此外，重要的背景因素可能会调节 ACO 影响。例如，ACO 通常不包括外科医生诊所和门诊手术中心， 提供越来越多的外科护理。如果这些手术提供者与患者的联系较弱 PCP 团体接受集体问责，ACO 对他们的影响可能会减弱。在此背景下， 我们提出一项研究，以更好地了解 ACO 对外科护理的影响。我们的建议有 以下三个具体目标。确定 ACO 对手术支出和质量的影响。 利用全国医疗保险人口，我们将确定符合医疗保险 ACO 的合格受益人，并且 那些不是的。然后，我们将比较这些受益人之前的手术费用和总体费用 以及 ACO 形成后。对于接受手术的受益人，我们还将评估他们的围手术期 结果和总情节付款。目标 2：评估 ACO 影响的临床异质性 提供外科护理。我们将根据目标 1 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 这些受益人在 ACO 之前和之后进行的高、中、低价值的外科手术 形成。目标 3：评估政策实施的异质性如何影响外科护理服务。 使用来自全国责任医疗组织调查的链接数据和网络分析工具， 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 效力。我们的研究结果将与医疗保健研究机构直接相关 质量研究优先领域#3，因为它们将为医疗保险中心的决策者提供信息 医疗补助服务部了解新的报销机制对医疗支出的影响。