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Prospective or retrospective ACO attribution matters for seriously ill patients.

Publication ,  Journal Article
Kaufman, BG; Bleser, WK; Saunders, R; Anderson, D; Van Houtven, CH; Muhlestein, DB; Clough, J; McClellan, MB
Published in: Am J Manag Care
December 2020

OBJECTIVES: Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and retrospective ACO populations. STUDY DESIGN: This retrospective, cross-sectional analysis describes survival, patient characteristics, and Medicare spending for Medicare fee-for-service beneficiaries identified with serious illness (n = 1,600,629) using 100% Medicare Master Beneficiary Summary and MSSP beneficiary files (2014-2016). METHODS: We used generalized linear models with ACO and year fixed effects to estimate the average within-ACO difference between potential retrospective and prospective ACO populations. RESULTS: Dying in the first 90 days of the performance year was associated with reduced odds of retrospective ACO attribution (odds ratio [OR], 0.24; 95% CI, 0.24-0.25) relative to beneficiaries surviving 270 days or longer. Similarly, hospice use was associated with reduced odds of retrospective assignment (OR, 0.80; 95% CI, 0.79-0.80). Among ACOs that did not achieve shared savings, average per capita Medicare expenditures (after truncation) were $2459 (95% CI, $2192-$2725) higher for prospective vs retrospective ACO populations. The difference was $834 (95% CI, $402-$1266) greater per capita among ACOs that achieved shared savings. CONCLUSIONS: The difference in survival and spending for ACO populations captured by prospective vs retrospective attribution methods means that ACOs may need to employ different care management strategies to improve performance depending on their attribution method.

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Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

December 2020

Volume

26

Issue

12

Start / End Page

534 / 540

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Prospective Studies
  • Medicare
  • Humans
  • Health Policy & Services
  • Cross-Sectional Studies
  • Cost Savings
  • Aged
  • Accountable Care Organizations
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kaufman, B. G., Bleser, W. K., Saunders, R., Anderson, D., Van Houtven, C. H., Muhlestein, D. B., … McClellan, M. B. (2020). Prospective or retrospective ACO attribution matters for seriously ill patients. Am J Manag Care, 26(12), 534–540. https://doi.org/10.37765/ajmc.2020.88541
Kaufman, Brystana G., William K. Bleser, Robert Saunders, David Anderson, Courtney H. Van Houtven, David B. Muhlestein, Jeffrey Clough, and Mark B. McClellan. “Prospective or retrospective ACO attribution matters for seriously ill patients.Am J Manag Care 26, no. 12 (December 2020): 534–40. https://doi.org/10.37765/ajmc.2020.88541.
Kaufman BG, Bleser WK, Saunders R, Anderson D, Van Houtven CH, Muhlestein DB, et al. Prospective or retrospective ACO attribution matters for seriously ill patients. Am J Manag Care. 2020 Dec;26(12):534–40.
Kaufman, Brystana G., et al. “Prospective or retrospective ACO attribution matters for seriously ill patients.Am J Manag Care, vol. 26, no. 12, Dec. 2020, pp. 534–40. Pubmed, doi:10.37765/ajmc.2020.88541.
Kaufman BG, Bleser WK, Saunders R, Anderson D, Van Houtven CH, Muhlestein DB, Clough J, McClellan MB. Prospective or retrospective ACO attribution matters for seriously ill patients. Am J Manag Care. 2020 Dec;26(12):534–540.

Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

December 2020

Volume

26

Issue

12

Start / End Page

534 / 540

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Prospective Studies
  • Medicare
  • Humans
  • Health Policy & Services
  • Cross-Sectional Studies
  • Cost Savings
  • Aged
  • Accountable Care Organizations