Casting doubt on value based cardiac care, a JAMA study found that outpatient cardiology practices enrolled in an accountable care organization (ACO) through the Medicare Shared Savings Program (MSSP) don’t offer better care than non-ACO practices.
- MSSP was introduced in 2012 to improve care quality and lower Medicare costs by having ACOs assume responsibility for Medicare beneficiaries’ costs and care quality.
- As an incentive, Medicare then makes fee-for-service payments and shares the savings with ACOs if cost and care quality benchmarks are met.
Evaluating the ACO incentives, researchers compared care quality data from the ACC’s NCDR PINNACLE Registry before and 6-12 months after MSSP participation at 83 ACO outpatient cardiology practices versus 332 non-ACO practices and found…
- MSSP ACO participation made no difference in coronary artery disease, HF, AFib, or hypertension outcomes.
- No changes in CVD drug prescriptions, LDL profiles, or smoking cessation.
- However, using a 24 month follow-up revealed increased beta-blocker use for HF (aOR: 1.23) as well as fewer patients with LDL profiles <100 mg/dL (0.71).
These results fly in the face of value based care’s promise to deliver better care, but the sub-analysis’ increased follow-up could suggest some benefits take longer to appear.
While their cardiac care benefits might not be clear, it’s worth remembering that ACOs are also intended to help save care costs.
- One AHA study back in 2019 found that annual spending for Medicare beneficiaries with CVD was ≈$200 lower when cared for by ACO cardiologists, without sacrificing quality.
The Takeaway
While cardiology practices might not get better through joining an ACO, they do seem to get more cost effective. Maybe that’s not such a bad deal considering the U.S.’s annual health care costs for cardiovascular conditions are projected to almost quadruple to $1.5T by 2050.
