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

Area of Science:

• Health Services Research
• Healthcare Policy
• Medicare Program Analysis

Background:

• Accountable Care Organizations (ACOs) aim to improve care quality and reduce costs for Medicare beneficiaries.
• Current Medicare beneficiary assignment rules primarily consider outpatient primary care providers.

Purpose of the Study:

• To evaluate the impact of including post-acute evaluation and management (E&M) services on Medicare beneficiary assignment to ACOs.
• To identify potential shifts in accountability for post-acute care patients under existing assignment methodologies.

Main Methods:

• Analysis of a 5% random sample of 2009 Medicare claims data.
• Linking claims data with American Medical Association Group Practice data to identify ACO-eligible entities.
• Calculation of beneficiary assignment shifts when post-acute E&M services were included in primary care attribution.

Main Results:

• Assignment shifts occurred for 27.6% of beneficiaries with skilled nursing facility stays.
• Shifts were more frequent among higher-spending beneficiaries.
• Beneficiaries whose assignment shifted represented a small fraction of the total population but a significant portion of Medicare spending.

Conclusions:

• Current Medicare assignment rules may lead to ACOs not being accountable for a significant group of post-acute patients.
• This exclusion represents a missed opportunity for improving care coordination and reducing hospital readmissions.
• Revising assignment rules could enhance ACOs' ability to manage the full continuum of care.