ArticleBMC health services research2017
Primary care focus and utilization in the Medicare shared savings program accountable care organizations.
Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Analysis of the current situation and influencing factors of burnout of medical insurance specialists in public hospitals in Guangxi, China under the background of the "Sanming Model" reform- cases of healthcare system reform from low and middle income regions.BMC health services research · 2026Article
- Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement.Journal of the American Heart Association · 2023Article
- Article
- Association between specialist compensation and Accountable Care Organization performance.Health services research · 2020Article
- Association Between Specialist Office Visits and Health Expenditures in Accountable Care Organizations.JAMA network open · 2019Article
- Regional Supply of Medical Resources and Systemic Overuse of Health Care Among Medicare Beneficiaries.Journal of general internal medicine · 2018Article
- Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care.Medical care · 2018Observational
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundAlthough Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).
methodsIn this retrospective cohort study, we divided the 220 MSSP ACOs into quartiles of primary care focus based on the percentage of all ambulatory evaluation and management services delivered by a PCP (internist, family physician, or geriatrician). Using multivariable regression, we evaluated rates of utilization and spending during the initial performance period, adjusting for the percentage of non-white patients, region, number of months enrolled in the MSSP, number of beneficiary person years, percentage of dual eligible beneficiaries and percentage of beneficiaries over the age of 74.
resultsThe proportion of ambulatory evaluation and management services delivered by a PCP ranged from <38% (lowest quartile, ACOs with least PCP focus) to >46% (highest quartile, ACOs with greatest PCP focus). ACOs in the highest quartile of PCP focus had higher adjusted rates of utilization of acute care hospital admissions (328 per 1000 person years vs 292 per 1000 person years, p = 0.01) and emergency department visits (756 vs 680 per 1000 person years, p = 0.02) compared with ACOs in the lowest quartile of PCP focus. ACOs in the highest quartile of PCP focus achieved no greater savings per beneficiary relative to their spending benchmarks ($142 above benchmark vs $87 below benchmark, p = 0.13).
conclusionsPrimary care focus was not associated with increased savings or lower utilization of healthcare during the initial implementation of MSSP ACOs.
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