ACO Spending and Utilization Among Medicare Patients at the End of Life: an Observational Study.
J Gen Intern Med
; 37(13): 3275-3282, 2022 10.
Article
em En
| MEDLINE
| ID: mdl-35022958
ABSTRACT
BACKGROUND:
End-of-life (EOL) costs constitute a substantial portion of healthcare spending in the USA and have been increasing. ACOs may offer an opportunity to improve quality and curtail EOL spending.OBJECTIVE:
To examine whether practices that became ACOs altered spending and utilization at the EOL.DESIGN:
Retrospective analysis of Medicare claims. PATIENTS We assigned patients who died in 2012 and 2015 to an ACO or non-ACO practice. Practices that converted to ACOs in 2013 or 2014 were matched to non-ACOs in the same region. A total of 23,643 ACO patients were matched to 23,643 non-ACO patients. MAINMEASURES:
Using a difference-in-differences model, we examined changes in EOL spending and care utilization after ACO implementation. KEYRESULTS:
The introduction of ACOs did not significantly impact overall spending for patients in the last 6 months of life (difference-in-difference (DID) = $192, 95%CI -$841 to $1125, P = 0.72). Changes in spending did not differ between ACO and non-ACO patients across spending categories (inpatient, outpatient, physician services, skilled nursing, home health, hospice). No differences were seen between ACO and non-ACO patients in rates of ED visits, inpatient admissions, ICU admission, mean healthy days at home, and mean hospice days at 180 and 30 days prior to death. However, non-ACO patients had a significantly greater increase in hospice utilization compared to ACO patients at 180 days (DID P-value = 0.02) and 30 days (DID P-value = 0.01) prior to death.CONCLUSIONS:
With the exception of hospice care utilization, spending and utilization were not different between ACOs and non-ACO patients at the EOL. Longer follow-up may be necessary to evaluate the impact of ACOs on EOL spending and care.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos na Terminalidade da Vida
/
Organizações de Assistência Responsáveis
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article