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Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic
The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare’s largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a p...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374212/ https://www.ncbi.nlm.nih.gov/pubmed/35960735 http://dx.doi.org/10.1371/journal.pone.0272706 |
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author | Yan, Brandon W. Shashoua, Maya Figueroa, Jose F. |
author_facet | Yan, Brandon W. Shashoua, Maya Figueroa, Jose F. |
author_sort | Yan, Brandon W. |
collection | PubMed |
description | The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare’s largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID’s impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p<0.001), driven by 14.6% and 7.5% reductions in per capita acute inpatient and outpatient spending, respectively. Utilization fell across inpatient, emergency, and outpatient settings. On quality metrics, preventive screening rates remained stable or improved, while control of diabetes and blood pressure worsened. Large reductions in non-COVID utilization helped ACOs succeed financially in 2020, but worsening chronic disease measures are concerning. The appropriateness of the benchmark methodology and exclusion of COVID-related spending, especially as the virus approaches endemicity, should be revisited to ensure bonus payments reflect advances in care delivery and health outcomes rather than COVID-related shifts in spending and utilization patterns. |
format | Online Article Text |
id | pubmed-9374212 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-93742122022-08-13 Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic Yan, Brandon W. Shashoua, Maya Figueroa, Jose F. PLoS One Research Article The COVID pandemic disrupted health care spending and utilization, and the Medicare Shared Savings Program (MSSP), Medicare’s largest value-based payment model with 11.2 million assigned beneficiaries, was no exception. Despite COVID, the 513 accountable care organizations (ACO) in MSSP returned a program record $1.9 billion in net savings to Medicare in 2020. To understand the extent of COVID’s impact on MSSP cost and quality, we describe how ACO spending changed in 2020 and further analyze changes in measured quality and utilization. We found that non-COVID per capita spending in MSSP fell by 8.3 percent from $11,496 to $10,537 (95% confidence interval(CI),-1,223.8 to-695.4, p<0.001), driven by 14.6% and 7.5% reductions in per capita acute inpatient and outpatient spending, respectively. Utilization fell across inpatient, emergency, and outpatient settings. On quality metrics, preventive screening rates remained stable or improved, while control of diabetes and blood pressure worsened. Large reductions in non-COVID utilization helped ACOs succeed financially in 2020, but worsening chronic disease measures are concerning. The appropriateness of the benchmark methodology and exclusion of COVID-related spending, especially as the virus approaches endemicity, should be revisited to ensure bonus payments reflect advances in care delivery and health outcomes rather than COVID-related shifts in spending and utilization patterns. Public Library of Science 2022-08-12 /pmc/articles/PMC9374212/ /pubmed/35960735 http://dx.doi.org/10.1371/journal.pone.0272706 Text en © 2022 Yan et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Yan, Brandon W. Shashoua, Maya Figueroa, Jose F. Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title_full | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title_fullStr | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title_full_unstemmed | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title_short | Changes in spending, utilization, and quality of care among Medicare accountable care organizations during the COVID-19 pandemic |
title_sort | changes in spending, utilization, and quality of care among medicare accountable care organizations during the covid-19 pandemic |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374212/ https://www.ncbi.nlm.nih.gov/pubmed/35960735 http://dx.doi.org/10.1371/journal.pone.0272706 |
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