Medicare Shared Savings Program cut PAC spending by 9%, study shows

Despite the spending cuts, patients' quality of care in the MSSP didn't suffer.
Despite the spending cuts, patients' quality of care in the MSSP didn't suffer.

Drops in skilled nursing admissions contributed to a 9% cut in post-acute spending for accountable care organizations in the Medicare Shared Savings Program, recent research found.

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. Their findings, published in the April issue of JAMA Internal Medicine, showed a reduction in post-acute spending for ACOs that joined the program in 2012.

By 2014 those ACOs achieved a 9% reduction in post-acute spending — or a drop of $106 per beneficiary, the study found. The results also showed reductions in post-acute spending to be similar for ACOs with financial ties to hospitals and those without.

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, researchers said. They also attributed the drop in post-acute use and length of stay to changes in the care received within hospitals or skilled nursing facilities by ACO patients.

Investigators found no association between participation in the MSSP and changes in readmission rates, use of nursing homes with high ratings, or mortality. The study also found no “ostensible deterioration” of beneficiaries' quality of care.

“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.”