A study published in Health Affairs of a large Pioneer ACO has found that there are substantial physician and patient turnover. The study was done over a three-year contract period.
The study examined organizational and Medicare data on Somerville, Mass.-based Partners ACO, which is a part of Boston-based Partners HealthCare from 2012 to 2014.
Turnover relationship with cost and outcome of ACO
During the study, researchers have found that only a small portion of the participating physicians’ patients was attributed to the concerned ACO. It has also found that physicians have joined and left the ACO regularly throughout the contract period, thus even bringing patients with them.
The authors wrote, ‘These findings may help explain the muted financial impact ACOs have had overall, and they raise the possibility of future gaming on the part of ACOs to artificially control spending’.
Two major findings
1. Less than 5% of a typical patient panel was assigned to the ACO.
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Over the span of three years of the contract, a total of 748 physicians has participated in the ACO. But according to the study, not all of these physicians had patients that attributed to the ACO while they were signed on to participate. In fact, 87 physicians didn’t even have an attributed beneficiary. For rest of the 661 physicians who did have attributed beneficiaries, the numbers were limited. So on an average, a physician had 70 patients attributed to the Accountable Care Organization. However, the average patient panel during the entire study period was around 1,700 patients.
The authors wrote, ‘This limited ACO penetration at the physician level could mitigate the ACO’s potential to achieve its financial targets, at least for any effects mediated through physician behavior’.
2. Physician turnover generated the patient turnover.
According to the study, only 52% of the physicians remained affiliated for the full three-year contract with the ACO. It is revealed that around 41% new physicians have joined the ACO and around 18% old physicians have left. The patients often tend to follow their respective physicians. The authors have found that 90% of the patients have left the ACO if their concerned physician left. On the growth part, half of patient growth could be attributed to the physicians joining the Accountable Care Organization.
The authors have suggested that these levels of turnover not only dilute the ACO’s overall financial and quality impact; but, at the same time, it also gamed to make Accountable Care Organization performance appears more favorably.
The authors wrote, ‘Because of the central role of physicians in linking beneficiaries with ACOs, however, changes in an ACO’s affiliated physicians also could represent intentional efforts by the ACOs to influence the composition of the attributed patient population, such as removing subpopulations having less favorable health risk profiles by dropping particular physicians, or vice versa’.
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Date: June 20, 2017
