Abstract
BackgroundLittle is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization’s costs. The purpose of this study was to determine whether joining an ACO is associated with an increase in a Rural Health Clinic’s (RHC’s) cost per visit.MethodsThe analyses focused on cost per visit in 2012 and 2013 for RHCs that joined an ACO in 2012 and cost per visit in 2013 for RHCs that joined an ACO in 2013. The RHCs were located in nine states. Data were obtained from Medicare Cost Reports. The analysis was conducted taking a treatment effects approach where the treatment is joining an ACO. Propensity-score matching was employed to provide multiple single and pooled estimates of the average treatment effect on the treated.ResultsFour-hundred thirty four to 544 RHCs (depending on the type of analysis and the variables used) were used in the several analyses. Seven of the RHCs joined an ACO in 2012 and 14 joined an ACO in 2013. The mean cost per visit for RHCs that did not join an ACO rose 4.40 % from 2011 to 2012 whereas the mean cost per visit for RHCs that joined an ACO rose by triple: 13.5 %. All of the pooled estimates of the average treatment effect on the treated from the propensity-score matching showed that joining an ACO was associated with higher mean cost per visit. The range of the estimated mean cost per visit differences was $17.19 (p value = 0.00) to $25.19 (p value = 0.00).ConclusionsThis study is one of the first to describe the cost of ACO participation from the perspective of primary care provider organizations. It appears that for at least one type of primary care provider - the RHC - there are substantial costs associated with ACO participation during the first two years.
Highlights
Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization’s costs
Some of the rural health clinic (RHC) that joined or formed Medicare Shared Savings Program (MSSP) ACOs were selected to participate in the Advance Payment Model ACO, which was developed by Centers for Medicare and Medicaid Services (CMS) to meet the needs of smaller ACOs, such as those composed of Hofler and Ortiz BMC Health Services Research (2016) 16:315 physician-based and rural providers
In the Background section we mentioned the dissimilar increases in cost per visit for RHCs that joined an ACO in 2012 compared to those that did
Summary
Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization’s costs. In late 2011, CMS released regulations regarding provider participation in ACOs. In late 2011, CMS released regulations regarding provider participation in ACOs These regulations included several provisions allowing primary care providers such as Rural Health Clinics (RHCs) to join Medicare Shared Savings Program (MSSP) ACOs, or to organize with other RHCs to become their own ACOs. Some of the RHCs that joined or formed MSSP ACOs were selected to participate in the Advance Payment Model ACO, which was developed by CMS to meet the needs of smaller ACOs, such as those composed of Hofler and Ortiz BMC Health Services Research (2016) 16:315 physician-based and rural providers. In this study we focus on Rural Health Clinics to determine the cost implications of ACO participation for rural primary care providers
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