Medicare accountable care organizations may find the incentive to manage healthcare quality and cost very weak. New research suggests patients frequently seek care outside of the ACOs they're assigned to, and many do not stay within the same ACO from one year to the next.
Researchers analyzed the 2010 and 2011 medical bills for Medicare patients they estimated were assigned to Medicare ACOs starting in 2012. Two-thirds of these patients' outpatient visits to specialists were outside the ACO and one-third of the patients did not receive care from the same ACO over the two years, according to the study by Dr. J. Michael McWilliams, Michael Chernew, Jesse Dalton and Dr. Bruce Landon of Harvard University. The results were published in the Journal of the American Medical Association Internal Medicine.
Hospitals and doctors in ACOs can earn bonuses or see losses depending on how successfully they meet quality targets and control health spending for the patients that Medicare assigns to them. More than 300 ACOs have signed Medicare contracts since 2012 and their leaders say the efforts to better coordinate and standardize care are key to delivering better outcomes at lower costs.