A study recently published in JAMA Internal Care found the majority of beneficiaries assigned to an accountable care organization went outside of their assigned ACO for specialty care.
Using Medicare claims data from 2010 to 2011 and lists of physicians who participate in ACO programs, the researchers examined the proportion of patients whose assignment to an ACO in 2010 was unchanged in 2011, the proportion of office visits that occurred outside of the ACO and the proportion of Medicare outpatient spending billed by the ACO that was devoted to assigned patients.
The study made the following findings:
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80 percent of the beneficiaries assigned to an ACO in 2010 were assigned to the same ACO in 2011.
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Beneficiaries with fewer conditions and office visits were more likely to have ACO assignment changes.
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9 percent of office visits with primary care physicians were provided outside of beneficiaries' assigned ACOs.
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The number of beneficiaries seeking outpatient specialty care outside of their assigned ACO was greater for higher-cost beneficiaries and occurred often even among specialty-oriented ACOs.
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38 percent of Medicare spending on outpatient care billed by ACO physicians was for assigned beneficiaries.
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