According to a recent study, implementation of pilot accountable care organizations (ACOs) does not limit spending on discretionary or non-discretionary cardiovascular treatment for patients. The study, entitled “Implementation of a pilot accountable care organization payment model and the use of discretionary and nondiscretionary cardiovascular care,” was recently published in the journal Circulation.
Researchers from Dartmouth and Michigan universities examined the implementation of ACOs in 10 large health systems, concluding that health systems need to directly consider specialty care in order to achieve meaningful savings.
The group subject to intervention included 819 ,779 patients from fee-for-service Medicare, who were taking part in a Medicare pilot accountable care organization project called Physician Group Practice Demonstration (PGPD). Additionally, the researchers used 934,621 patients as a control group. The team then compared use of cardiovascular care before and after PGPD implementation, and evaluated discretionary and nondiscretionary carotid and coronary imaging methods.
“We found that, when an ACO payment model was implemented, evidence-based treatments for patients with cardiovascular disease, such as heart attack or stroke, were provided consistently,” said study author Dr. Carrie Colla in a recent news release “That’s a good thing. However, we also found that discretionary tests and procedures, such as stress tests for people without symptoms, were still being commonly ordered. We hypothesized that pilot ACOs would target these discretionary treatments to help lower spending, but that didn’t happen. For ACOs, which need to focus on limiting spending on discretionary treatments, this is a missed opportunity.”
Results revealed that implementation of a pilot accountable care organization does not limit the use of discretionary or nondiscretionary cardiovascular care.
“We looked very closely at our results, wondering if perhaps some pilot ACOs fared better than others,” explained study author Dr. Philip P. Goodney. “However, for every ACO in the study that spent a little less, another ACO spent a little more. As a result, ACO providers as a group didn’t limit spending when compared to the control group of providers without pilot ACOs.”
“To achieve meaningful savings, ACOs need to consider specialty care directly,” added study author Dr.Ellen Meara in the news release ” This should be in addition to their focus on the spending by primary care physicians. It’s clear that more savings are possible, but it’s going to take hospital leaders involving the entire care team.”