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Post-acute care and ACOs - who will be accountable?

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  • المؤلفون: McWilliams JM;McWilliams JM; Chernew ME; Zaslavsky AM; Landon BE
  • المصدر:
    Health services research [Health Serv Res] 2013 Aug; Vol. 48 (4), pp. 1526-38. Date of Electronic Publication: 2013 Jan 27.
  • نوع النشر :
    Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • اللغة:
    English
  • معلومة اضافية
    • المصدر:
      Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE
    • بيانات النشر:
      Publication: Malden, MA : Blackwell
      Original Publication: Chicago, Hospital Research and Educational Trust.
    • الموضوع:
      Accountable Care Organizations/*organization & administration ; Critical Care/*organization & administration; Accountable Care Organizations/economics ; Continuity of Patient Care/economics ; Continuity of Patient Care/organization & administration ; Health Care Costs/statistics & numerical data ; Humans ; Medicare/economics ; Medicare/organization & administration ; Medicare Assignment/economics ; Medicare Assignment/organization & administration ; United States
    • نبذة مختصرة :
      Objective: To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs).
      Data Sources: Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Association Group Practice data identifying provider groups sufficiently large to be eligible for ACO program participation.
      Study Design: We calculated the fraction of community-dwelling beneficiaries whose assignment shifted, as a consequence of including post-acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post-acute care.
      Principal Findings: Assignment shifts occurred for 27.6 percent of 25,992 community-dwelling beneficiaries with at least one post-acute skilled nursing facility stay, and they were more common for those incurring higher Medicare spending. Those whose assignment shifted constituted only 1.3 percent of all community-dwelling beneficiaries cared for by large ACO-eligible organizations (n = 535,138), but they accounted for 8.4 percent of total Medicare spending for this population.
      Conclusions: Under current Medicare assignment rules, ACOs may not be accountable for an influential group of post-acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions.
      (© Health Research and Educational Trust.)
    • References:
      Health Aff (Millwood). 2007 Nov-Dec;26(6):1753-61. (PMID: 17978395)
      Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64. (PMID: 20048361)
      N Engl J Med. 2011 Sep 29;365(13):1165-7. (PMID: 21991889)
      J Am Geriatr Soc. 2000 Feb;48(2):154-63. (PMID: 10682944)
      Milbank Q. 2007 Dec;85(4):579-610. (PMID: 18070331)
    • Grant Information:
      K08 AG038354 United States AG NIA NIH HHS; P01 AG032952 United States AG NIA NIH HHS
    • Contributed Indexing:
      Keywords: Medicare; accountable care organizations; delivery of health care; health care costs; skilled nursing facilities
    • الموضوع:
      Date Created: 20130129 Date Completed: 20130916 Latest Revision: 20211021
    • الموضوع:
      20221213
    • الرقم المعرف:
      PMC3703488
    • الرقم المعرف:
      10.1111/1475-6773.12032
    • الرقم المعرف:
      23350910