ACOs cut costs, not quality

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Post-acute care spending dropped by 9% — or about $106 per beneficiary — without a drop in quality, a study of accountable care organizations in the Medicare Shared Savings Program has found.

Success relied on clinicians working within skilled nursing facilities and hospitals directly influencing care for ACO patients, rather than focused use of “preferred” SNFs or broad hospital initiatives, researchers found.

The Medicare Shared Services Program is the largest of its kind testing alternative payment models.

Researchers with Harvard Medical School and Vanderbilt University School of Medicine analyzed Medicare claims to track changes in post-acute care linked to participation in the MSSP. ACOs that joined the program in the first year (2012) showed the best reductions in costs. 

The decrease in spending was primarily driven by fewer patients being discharged into skilled nursing facilities and shorter lengths of stay for those who were admitted.

“Payment models that place hospitals at risk for post-acute spending are not the only viable strategy to curb excessive post-acute care,” the research team wrote. “Therefore, accountable care organizations' incentives to achieve post-acute savings should not be weakened.”

Findings appeared in JAMA Internal Medicine