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Changes in Postacute Care in the Medicare Shared Savings Program.

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This summary is machine-generated.

Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) reduced postacute care spending by influencing care within hospitals and skilled nursing facilities (SNFs). This demonstrates ACOs

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Area of Science:

  • Health Economics
  • Healthcare Management
  • Quality Improvement

Background:

  • Postacute care represents a significant area of potential healthcare spending waste.
  • Accountable Care Organizations (ACOs) are designed to improve care coordination and reduce costs.
  • Understanding ACOs' impact on postacute care spending is crucial for evaluating payment models.

Purpose of the Study:

  • To evaluate changes in postacute care spending and utilization among providers participating in the Medicare Shared Savings Program (MSSP).
  • To identify the pathways through which ACO participation influences postacute care utilization and spending.

Main Methods:

  • Utilized fee-for-service Medicare claims data from a 20% random sample of beneficiaries (2009-2014).
  • Employed difference-in-difference analysis comparing beneficiaries served by ACOs versus a control group of non-ACO providers.
  • Analyzed data for ACOs entering the MSSP in 2012, 2013, and 2014, assessing changes before and after program entry.

Main Results:

  • The 2012 ACO cohort showed a significant reduction in postacute spending (-$106 per beneficiary, -9.0%) driven by decreased acute inpatient care, fewer discharges to skilled nursing facilities (SNFs), and shorter SNF stays.
  • Reductions in SNF utilization and length of stay were primarily attributed to changes in care within hospitals and SNFs for ACO patients.
  • The 2013 ACO cohort also demonstrated a significant reduction in postacute spending (-$27 per beneficiary, -3.3%), but no significant changes were observed for the 2013 or 2014 cohorts in their first year of participation.
  • No significant association was found between MSSP participation and changes in 30-day readmissions, use of highly-rated SNFs, or mortality.

Conclusions:

  • Participation in the MSSP is associated with significant reductions in postacute care spending without compromising care quality.
  • Spending reductions appear to stem from enhanced care coordination within hospitals and SNFs rather than broad hospital-wide initiatives or preferred SNF utilization.
  • Findings support the effectiveness of ACO models in managing postacute care costs through targeted clinical practice improvements.