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Cited by 163Healthcare Policy and ManagementPrimary Care and Health OutcomesHealthcare cost, quality, practices

Spending differences associated with the Medicare Physician Group Practice Demonstration

Open access
Colla, Carrie H., Wennberg, David E., Meara, Ellen, Skinner, Jonathan S., Gottlieb, Daniel, Lewis, Valerie A., Snyder, Christopher M., Fisher, Elliott S.·2012·JAMA
DOI 10.1001/2012.jama.10812PMC PMC3484377
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Abstract

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.

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  • Available evaluations indicate that health care spending has declined in ACO models.

    “Most ACO models are very new, but available evaluations indicate that health care spending has declined.”

    From The CardioMetabolic Health Alliance (2015) · cites this paper as [104]

  • An evaluation of Medicare enrollees in the Medicare Physician Group Practice Demonstration compared with control subjects found that the savings were highest for acute care and dually-eligible beneficiaries, with an overall reduction in 30-day medical readmissions.

    “An evaluation of Medicare enrollees in the Medicare Physician Group Practice Demonstration compared with control subjects found that the savings were highest for acute care and dually-eligible beneficiaries, with an overall reduction in 30-day medical readmissions (104).”

    From The CardioMetabolic Health Alliance (2015) · cites this paper as [104]

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Authors
Colla, C. H., Wennberg, D. E., Meara, E., Skinner, J. S., Gottlieb, D., Lewis, V. A., Snyder, C. M., & Fisher, E. S.
Affiliations
  • Dartmouth Institute for Health Policy and Clinical Practice (US)
  • Dartmouth College (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2012-09-12
Volume
308
Issue
10
Pages
1015
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/2012.jama.10812
PMC
PMC3484377
OpenAlex
W2105933035
Cited by
163
References
32
Citations by year
2025: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 9 · 2018: 22 · 2017: 13 · 2016: 20 · 2015: 17 · 2014: 36 · 2013: 30 · 2012: 5
FWCI
67.10
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (R33AG044251, P01AG19783, R21AG044251, P01AG019783)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Keywords
accountable care organizations, Medicare spending, cost reduction, Medicare-Medicaid dual eligibles, fee-for-service Medicare, acute care costs, risk adjustment, physician practice groups, health care cost containment, quality incentives, 30-day readmission
MeSH terms
Aged, Eligibility Determination, Health Expenditures, Patient Care, Group Practice, Medicare, Humans, Medicaid, Physicians, Reimbursement, Incentive, United States, Cost Savings, Fee-for-Service Plans

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