Reform Update: ACOs more likely to be in markets with hospital, doctor consolidation, study finds

In five markets around the country, accountable care organizations were providing care to more than half the Medicare patients in the traditional fee-for-service program, a new study found. In addition, ACOs were more likely to be found in markets with greater consolidation by hospitals and doctors.

Researchers with Rand Corp. and Harvard University identified five markets where more than half the traditional Medicare beneficiaries were served by Medicare ACOs, either those participating in the Medicare Pioneer program or the Medicare Shared Savings program. The authors identified the markets in a map included in the study.

In another 26 hospital markets, Medicare ACOs served up 20% to up to half of seniors in traditional Medicare, the study found.

David Auerbach, one of the study's authors and a RAND policy researcher, said ACO prevalence may be greater in some markets than is reflected in the study's results because researchers could not include 106 Medicare ACOs, due to limited data.

The authors analyzed 32 Medicare Pioneer accountable care organizations, 116 Medicare Shared Savings ACOs and 72 private-market ACOs.

Nearly everywhere else, ACOs covered a much lower percentage of the traditional Medicare beneficiaries. In one out of five markets, 5% to 20% of Medicare fee-for-service enrollees were included in ACOs. The remaining two-thirds of markets saw fewer than 5% of Medicare fee-for-service enrollees in ACOs.

The study, published in the journal Health Affairs, found that Medicare ACOs were more prevalent in markets where more hospitals operated within a hospital system, more doctors worked in a practice of at least 10 physicians and hospitals had a greater share of risk contracts. The findings were similar for an analysis of private-market ACOs, they said.

“We found that increased provider integration appears to be a key marker of where ACOs are forming,” the authors wrote.

The researchers also said their data on integration pre-dated ACO formation. Auerbach said he would like to continue the research with more sophisticated measures of market integration, such as integration between hospitals and doctors.

Notably, high Medicare spending in a market did not appear to be related to ACO formation and penetration.

“There is much policy interest in whether ACOs are forming in high-cost regions of the country,” wrote Auerbach, Hangsheng Liu, Peter Hussey, Christopher Lau and Ateev Mehrotra. “If ACOs succeed in reducing spending, formation in these areas could mitigate geographic variation in Medicare spending. However, we found no strong pattern in the relationship between ACO penetration and Medicare spending or spending growth.”

According to new Medical Group Management Association research released today, medical group practices are sounding a cautious note surrounding state insurance exchange implementation. A week into the open enrollment period for ACA insurance exchanges, 40% of responding physician practices reported that they are still weighing their options on whether to participate in exchange health plans. The MGMA research includes responses from more than 1,000 medical groups in which more than 47,500 physicians practice nationwide.

While a majority of MGMA survey respondents see potential opportunities to provide care to an underserved patient population and replace current charity care, more than 80% cited concerns about the burden of patient collections on practices and low provider reimbursement rates as major barriers to their participation.

“Some insurers want practices to sign contracts for less than their current commercial rates, but are unable or unwilling to provide detailed information to physicians about how the exchange products will be administered,” said Dr. Susan Turney, MGMA president and CEO, in a news release.

Most physician groups reported that they do not expect a flood of new patients as a result of ACA exchanges. Almost 70% of respondents expected no change or only a slight increase to their patient population. More than half of physician practices did not plan to make any business changes, and fewer than 5% anticipated hiring new physicians, extending business hours, or adding clinical support staff.

Follow Melanie Evans on Twitter: @MHmevans