Quality of care for heart patients does not improve in first year of ACO participation
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Outpatient cardiology practices that participate in an accountable care organization (ACO) as part of the Medicare Shared Savings Program (MSSP) do not experience immediate improvements in the quality of care they provide, according to new findings published in JAMA Cardiology.[1]
“In 2012, the U.S. Centers for Medicare and Medicaid Services introduced the MSSP to lower cost and improve care quality across ambulatory practices by promoting care coordination, infrastructure investment and care redesign,” explained first author Erica S. Spatz, MD, a cardiologist and clinical investigator with the Center for Outcomes Research and Evaluation at Yale School of Medicine, and colleagues. “Through this program, groups of physicians, clinics, and hospitals formed ACOs that took responsibility for the cost and quality of care for a designated group of Medicare beneficiaries. Medicare made fee-for-service payments and shared the savings with ACOs if predetermined cost benchmarks were met, with payments adjusted based on a quality performance score. By 2018, there were more than 500 participating ACOs.”
Hoping to learn more about how ACO participation impacts patient outcomes, Spatz et al. explored data from the American College of Cardiology’s NCDR PINNACLE Registry for 415 outpatient cardiology practices. While 20% of those practices participated in an ACO, the remaining 80% did not.
The group focused on data from more than 7.8 million patients who underwent treatment from January 2013 to March 2019. The quality of care these patients received was measured by using 15 different performance measures related to the treatment of hypertension, coronary artery disease (CAD), heart failure and atrial fibrillation (AFib).
“We hypothesized that practices that joined an ACO would be better equipped to meet performance measures on several measures related to cardiovascular disease, because of both coordination with primary care and the potential for advanced data feedback to close gaps in care,” the authors wrote.
The researchers examined data from more than 30.7 million patient encounters. For practices that did join an ACO, data from before they joined was compared to six and 12 months after they joined.
Overall, the authors found, taking part in an ACO appeared to make a minimal impact on the quality of patient care.
“This study found that participation in the MSSP ACO program was not associated with significant changes in process-of-care measures for cardiovascular disease at a subset of outpatient cardiology practices across the United States within the first year of participation,” the group wrote. “Contrary to our hypothesis, across 15 quality measures in hypertension, CAD, heart failure and AFib, participation in an ACO was not associated with better-quality care as compared with non–ACO-participating practices when adjusted for secular trends among non–ACO-participating practices.”
The group also ran a subanalysis of some ACO practices by tracking data for a full two years after they first started participating. In that case, the authors did identify two differences: beta blocker use for heart failure patients improved, and the number of LDL profiles lower than 100 mg/dL declined.
“These findings raise questions about the magnitude and duration of time necessary for quality-improvement strategies to take hold to improve population health, as well as whether other contemporaneous initiatives to improve cardiovascular care attenuated the associations of MSSP-specific efforts around cardiovascular health,” the authors wrote.
Spatz and colleagues wrote that there could be different reasons for this small impact. It could take more than one or two years for ACO leaders to get the systems in place necessary to truly make a difference, for instance, and it is possible that ACOs are focusing more on primary care physicians than specialists right now.
Another possibility is that practices are also participating in other value-based programs, making it more challenging to investigate their value in the specific terms used for this analysis.
“Cardiologists operating across these models likely adopted uniform strategies for quality improvement, which could dilute or enhance the measurable associations with ACO participation,” the authors explained. “Understanding how these programs collectively influence care practices would provide a more comprehensive view of the dynamics between overlapping value-based initiatives.”
Click here to read the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.