Document Detail


Spending differences associated with the Medicare Physician Group Practice Demonstration.
MedLine Citation:
PMID:  22968890     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: The Centers for Medicare & Medicaid Services (CMS) recently launched accountable care organization (ACO) programs designed to improve quality and slow cost growth. The ACOs resemble an earlier pilot, the Medicare Physician Group Practice Demonstration (PGPD), in which participating physician groups received bonus payments if they achieved lower cost growth than local controls and met quality targets. Although evidence indicates the PGPD improved quality, uncertainty remains about its effect on costs.
OBJECTIVE: To estimate cost savings associated with the PGPD overall and for beneficiaries dually eligible for Medicare and Medicaid.
DESIGN: Quasi-experimental analyses comparing preintervention (2001-2004) and postintervention (2005-2009) trends in spending of PGPD participants to local control groups. We compared estimates using several alternative approaches to adjust for case mix.
SETTING: Ten physician groups from across the United States.
PATIENTS AND PARTICIPANTS: The intervention group was composed of fee-for-service Medicare beneficiaries (n = 990,177) receiving care primarily from the physicians in the participating medical groups. Controls were Medicare beneficiaries (n = 7,514,453) from the same regions who received care largely from non-PGPD physicians. Overall, 15% of beneficiaries were dually eligible for Medicare and Medicaid.
MAIN OUTCOME MEASURE: Annual spending per Medicare fee-for-service beneficiary.
RESULTS: Annual savings per beneficiary were modest overall (adjusted mean $114, 95% CI, $12-$216). Annual savings were significant in dually eligible beneficiaries (adjusted mean $532, 95% CI, $277-$786), but were not significant among nondually eligible beneficiaries (adjusted mean $59, 95% CI, $166 in savings to $47 in additional spending). The adjusted mean spending reductions were concentrated in acute care (overall, $118, 95% CI, $65-$170; dually eligible: $381, 95% CI, $247-$515; nondually eligible: $85, 95% CI, $32-$138). There was significant variation in savings across practice groups, ranging from an overall mean per-capita annual saving of $866 (95% CI, $815-$918) to an increase in expenditures of $749 (95% CI, $698-$799). Thirty-day medical readmissions decreased overall (-0.67%, 95% CI, -1.11% to -0.23%) and in the dually eligible (-1.07%, 95% CI, -1.73% to -0.41%), while surgical readmissions decreased only for the dually eligible (-2.21%, 95% CI, -3.07% to -1.34%). Estimates were sensitive to the risk-adjustment method.
CONCLUSIONS: Substantial PGPD savings achieved by some participating institutions were offset by a lack of saving at other participating institutions. Most of the savings were concentrated among dually eligible beneficiaries.
Authors:
Carrie H Colla; David E Wennberg; Ellen Meara; Jonathan S Skinner; Daniel Gottlieb; Valerie A Lewis; Christopher M Snyder; Elliott S Fisher
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  308     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-12     Completed Date:  2012-09-14     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1015-23     Citation Subset:  AIM; IM    
Affiliation:
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Pkwy, Lebanon, NH 03766, USA. Carrie.H.Colla@Dartmouth.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Cost Savings*
Eligibility Determination
Fee-for-Service Plans / economics
Group Practice / economics*
Health Expenditures / statistics & numerical data*
Humans
Intervention Studies
Medicaid / economics
Medicare / economics*
Patient Care / economics
Physicians / economics
Reimbursement, Incentive*
United States
Grant Support
ID/Acronym/Agency:
P01 AG019783/AG/NIA NIH HHS; P01AG19783/AG/NIA NIH HHS; R21 AG044251/AG/NIA NIH HHS
Comments/Corrections
Comment In:
JAMA. 2013 Jan 2;309(1):31   [PMID:  23280216 ]
JAMA. 2013 Jan 2;309(1):30-1   [PMID:  23280215 ]
JAMA. 2012 Sep 12;308(10):1038-9   [PMID:  22968894 ]

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