ACOs Challenged by Unrestricted Patient Choice

A study published online in JAMA Internal Medicine found that Medicare accountable care organizations could face challenges with controlling costs and managing patient care due to the unrestricted choice of health providers offered to most beneficiaries. About 33 of Medicare beneficiaries assigned to ACOs in 2010 or 2011 were not assigned to the same ACO in both years, and much of the specialty care they received was outside the patients’ assigned ACO. The study authors noted that among ACO-assigned beneficiaries, 8.7 percent of office visits with primary care physicians and 66.7 percent of office visits with specialists were provided outside of the assigned ACO. About 38 percent of Medicare spending on outpatient care billed by ACO physicians was devoted to assigned beneficiaries. Annual changes in patient populations of ACOs can make care management for specific patients more difficult. “Leakage of outpatient specialty care, particularly among high-cost and medically complex patients, could pose a significant care coordination challenge to ACOs and substantially limit their ability to achieve economies of scope in both patient-specific and systemic approaches to controlling spending,” the authors said.


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