Association of Physician Group Participation in Accountable Care Organizations With Patient Social and Clinical Characteristics

Werner, Rachel M.; Kanter, Genevieve P.; Polsky, Daniel

doi:10.1001/jamanetworkopen.2018.7220

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…1 Previous studies have noted discontinuities in specific disease or population subgroups. [2][3][4][5][6][7][8] This interrupted time series analysis and crosssectional study sought to quantify the magnitude of change in prevalence in all diagnostic categories for 3 widely used diagnostic classification systems and to explore potential reasons for these changes through selected clinical review.…”

Section: International Statistical Classification Of Diseases Tenth mentioning

confidence: 99%

“…To visualize patterns of observed changes, we created time series graphs for all diagnostic categories in each classification system. Each graph depicts 3 normalized series: (1) observed diagnostic category prevalence, (2) piecewise linear model predicted prevalence, and (3) locally estimated scatterplot smoothing curves, fit separately to the pretransition and posttransition periods. This last series helps to visualize possible nonlinear trends.…”

Section: Data Interpretation and Visualizationmentioning

confidence: 99%

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Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification

et al. 2020

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IMPORTANCE On October 1, 2015, the US transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for recording diagnoses, symptoms, and procedures. It is unknown whether this transition was associated with changes in diagnostic category prevalence based on diagnosis classification systems commonly used for payment and quality reporting. OBJECTIVE To assess changes in diagnostic category prevalence associated with the ICD-10-CM transition. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis and cross-sectional study examined level and trend changes in diagnostic category prevalence associated with the ICD-10-CM transition and clinically reviewed a subset of diagnostic categories with changes of 20% or more. Data included insurance claim diagnoses from the IBM MarketScan Commercial Database from January 1, 2010, to December 31, 2017, for more than 18 million people aged 0 to 64 years with private insurance. Diagnoses were mapped using 3 common diagnostic classification systems: World Health Organization (WHO) disease chapters,

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Section: International Statistical Classification Of Diseases Tenth mentioning

confidence: 99%

Section: Data Interpretation and Visualizationmentioning

confidence: 99%

Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification

et al. 2020

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“…An early, cross-sectional analysis using 2011 data found that ACO-attributed patients were less likely than non-ACO-attributed patients to be black, disabled, or vulnerable from the perspective of being Medicare/Medicaid dual-eligible (29). In contrast, a subsequent cohort study using longitudinal 2012-2014 data found that physician groups participating in the MSSP cared for more clinically high-risk patients and comparable numbers of socially vulnerable patients, as compared with nonparticipating physician groups (53). A separate observational analysis of MSSP ACOs demonstrated that patients with higher clinical risk scores were more likely than patients with lower risk scores to exit the program, a finding that suggests avoidance of high-risk patients could occur under ACOs (42).…”

Section: Unintended Consequences Of Population-and Episode-based Payment Models Health Care Disparitiesmentioning

confidence: 94%

The Impact of Medicare's Alternative Payment Models on the Value of Care

Liao

Navathe

Werner

2020

Annu. Rev. Public Health

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Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.

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“…16 However, the evidence that ACOs avoid vulnerable patients is inconsistent. Work has demonstrated that compared with nonparticipating groups, physician groups participating in the MSSP took care of a similar proportion of patients who are racial minorities, dually enrolled in Medicare and Medicaid, or living in a high-poverty zip code 17 and that ACOs with a high proportion of minority patients are committed to the mission of MSSP. 18 Accountable care organizations may worsen disparities even if physician groups care for similar proportions of socially vulnerable patients when they join the ACO if, once joining, physician groups reduce the share of vulnerable patients in their panels after joining an ACO, a practice known as cream-skimming.…”

Section: Introductionmentioning

confidence: 99%

Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations

et al. 2020

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IMPORTANCE The incentive structure of accountable care organizations (ACOs) may lead to participating physician groups selecting fewer vulnerable patients. OBJECTIVE To test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining the ACO. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician groups from 2010 to 2016. Medicare Shared Savings Program (MSSP) participation was determined using ACO files. Analyses were conducted between January 1, 2019, and February 25, 2020. EXPOSURES Using linear probability models, we conducted difference-indifferences analyses based on the year a physician group joined an ACO to estimate changes in vulnerable patients within ACO-participating groups compared with nonparticipating groups. MAIN OUTCOMES AND MEASURES Whether the patient was black, was dually enrolled in Medicare and Medicaid, and poverty and unemployment rates of the patient's zip code. RESULTS In a cohort of 76 717 physician groups caring for 7 307 130 patients, 16.1% of groups caring for 27.8% of patients participated in an MSSP ACO. Using 2010 characteristics, patients attributed to ACOs from 2012 to 2016, compared with those who were not, were less likely to be black (8.0% [n = 81 698] vs 9.3% [n = 270 924]) or dually enrolled in Medicare and Medicaid (12.8% [n = 130 957] vs 18.2% [n = 528 685]), and lived in zip codes with lower poverty rates (13.8% vs 15.5%); unemployment rates were similar (8.0% vs 8.5%). In the difference-indifferences analysis, there was no statistically significant change associated with ACO participation in the proportions of vulnerable patients attributed to ACO-participating groups compared with nonparticipating groups. After joining an ACO, ACO-participating groups had 0.0 percentage points change (95% CI, −0.1 to 0.1 percentage points; P = .59) for black patients, −0.1 percentage points (95% CI, −0.2 to 0.1 percentage points; P = .32) for patients dually enrolled in Medicare and Medicaid, 0.2 percentage points (95% CI, −3.5 to 4.0 percentage points; P = .91) in poverty rates, and −0.4 percentage points (95% CI, −2.0 to 1.2 percentage points; P = .62) in unemployment rates. CONCLUSIONS AND RELEVANCE In this cohort study, there were no changes in the proportions of vulnerable patients cared for by ACO-participating physician groups after joining an ACO compared with changes among nonparticipating groups.

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Association of Physician Group Participation in Accountable Care Organizations With Patient Social and Clinical Characteristics

Cited by 14 publications

References 24 publications

Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification

Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification

The Impact of Medicare's Alternative Payment Models on the Value of Care

Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations

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