News Feature | February 20, 2015

ACOs Don't Limit Use Of Cardiovascular Care

Christine Kern

By Christine Kern, contributing writer

Shared Accountability Between Patients And Providers

ACOs do not capitalize on savings opportunities, according to latest study.

A study conducted by Dartmouth College and the University of Michigan researches has concluded the implementation of pilot accountable care organizations at 10 large health systems did not limit discretionary or non-discretionary cardiovascular treatment for patients.

The paper, Implementation of a Pilot Accountable Care Organization Payment Model and the Use of Discretionary and Nondiscretionary Cardiovascular Care, was published by the American Heart Association and demonstrates health systems need to directly consider specialty care in order to achieve meaningful savings.

Lead author Carrie Colla, health economist from Dartmouth, explains in a release, “We found that, when an ACO payment model was implemented, evidence-based treatments for patients with cardiovascular disease, such as heart attack or stroke, were provided consistently. That’s a good thing.”

“However, we also found that discretionary tests and procedures, such as stress tests for people without symptoms, were still being commonly ordered. We hypothesized that pilot ACOs would target these discretionary treatments to help lower spending, but that didn’t happen. For ACOs, which need to focus on limiting spending on discretionary treatment, this is a missed opportunity.”

The intervention group in this study was composed of fee-for-service Medicare patients from 10 groups participating in a Medicare pilot ACO organization called the Physician Group Practice Demonstration (PGPD). The controls were organizations in the same region without pilot ACOs. The study considered cardiovascular care before and after implementation of the PGPD.

“To achieve meaningful savings, ACOs need to consider specialty care directly,” said co-author Ellen Meara, Ph.D. “This should be in addition to their focus on the spending by primary care physicians. It's clear that more savings are possible, but it's going to take hospital leaders involving the entire care team.”

“We looked very closely at our results, wondering if perhaps some pilot ACOs fared better than others,” explained co-author Philip P. Goodney, MD, MS. “However, for every ACO in the study that spent a little less, another ACO spent a little more. As a result, ACO providers as a group didn't limit spending when compared to the control group of providers without pilot ACOs.”

Looking forward, the Dartmouth team suggests that a more global approach within health systems that involves everyone from primary care physicians to specialists is needed to realize potential savings in an ACO model.