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 New Study Says Post-Acute Spending Drops Under Medicare ACOs

Research in the April JAMA Internal Medicine publication said accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) saw a 9 percent reduction in post-acute spending by 2014, mostly as a result of reductions in discharges to facility-based care, length of facility stays, and acute inpatient care.

The report, “Changes in Postacute Care in the Medicare Shared Savings Program,” by researchers from Harvard Medical School, Brigham and Women’s Hospital in Boston, and Vanderbilt University School of Medicine said there is a definite tie between ACOs and post-acute care.

“Participation in the MSSP has been associated with significant reductions in postacute spending without ostensible deterioration in quality of care,” the study said. “Spending reductions were more consistent with clinicians working within hospitals and SNFs [skilled nursing facilities] to influence care for ACO patients than with hospital-wide initiatives by ACOs or use of preferred SNFs.”

Researchers conducted their study by using fee-for-service Medicare claims from a random 20 percent sample of beneficiaries, totaling more than 25 million patient years and 8 million hospital admissions, along with 1.5 million-plus stays in SNFs from Jan. 1, 2009, to Dec. 31, 2014.

The data were then analyzed by conducting difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local, non-ACO health care professionals before and after entry into the MSSP.

Results for the 2012 group of 114 ACOs taking part in the MSSP were associated with the overall reduction in post-acute spending of $106 per beneficiary, or 9 percent of the cost “driven by differential reductions in acute inpatient care, discharge to facilities rather than home, and length of SNF stays,” the report said. “Reductions in use of SNFs and length of stay were largely due to within-hospital or within-SNF changes in care specifically for ACO patients.”

Researchers said the cost savings tied to ACOs in the MSSP for the 2013 cohort were lower than for the 2012 group, at just 3.3 percent. Further, the authors said participation in the MSSP was not tied to widespread changes in 30-day readmissions, use of highly rated SNFs, or mortality.

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