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Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.
- Source :
-
Health affairs (Project Hope) [Health Aff (Millwood)] 2016 Mar; Vol. 35 (3), pp. 440-8. - Publication Year :
- 2016
-
Abstract
- Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.<br /> (Project HOPEāThe People-to-People Health Foundation, Inc.)
- Subjects :
- Accountable Care Organizations trends
Aged
Aged, 80 and over
Benchmarking economics
Databases, Factual
Female
Health Care Surveys
Humans
Male
Medicare statistics & numerical data
Retrospective Studies
Sensitivity and Specificity
United States
Accountable Care Organizations economics
Health Expenditures statistics & numerical data
Medicare economics
Risk Adjustment economics
Subjects
Details
- Language :
- English
- ISSN :
- 1544-5208
- Volume :
- 35
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Health affairs (Project Hope)
- Publication Type :
- Academic Journal
- Accession number :
- 26953298
- Full Text :
- https://doi.org/10.1377/hlthaff.2015.1026