JAMA report findings support integrated, risk-sharing ACOs, authors say
Larger independent physician groups with “strong primary-care orientations” and where doctors have accepted greater financial risk deliver better quality care for Medicare beneficiaries at lower cost, according to a report in JAMA Internal Medicine.
Researchers with Harvard Medical School's healthcare policy department studied 2009 Medicare claims for almost 4.3 million beneficiaries and compared spending and quality measures for small (one to 10 doctors), medium-to-large and hospital-based physician groups. Quality measures included 30-day hospital readmissions, and mammography, diabetes and cholesterol screening for the appropriate patients.
Larger, hospital-based groups had higher spending and 30-day readmission rates than smaller groups, the researchers found. But large, independent groups performed better on the process measures and spent less per beneficiary—especially in counties where physician risk sharing was more common. Hospital-based groups with strong primary-care orientations, however, spent less and scored better on readmission and diabetes care measures than their hospital-based counterparts with less emphasis on primary care.
The authors, led by Dr. J. Michael McWilliams, suggested that there may be policy implications with their study. The results, McWilliams wrote, show that the mix of specialties among medical staff can affect quality and spending; that continued specialty consolidation may contribute to higher Medicare fee-for-service spending; and that strengthening the delivery of primary care while promoting system integration and provider risk-sharing may improve quality and lower spending.
The findings, the authors note, support the concept behind accountable care organizations in which integration, risk sharing and primary care are promoted. But, because spending and quality findings for medium-sized and larger independent groups were similar, the “study provides no suggestion that organizational size will predict performance among ACOs.”
The researchers produced a separate study published in the Journal of American Medical Association this week examining the benefits that spill over to Medicare from private-payer accountable care contracts .
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