By creator to www.healio.com
December 04, 2020
2 min learn
Accountable care organizations generated modest financial savings within the care of Medicare beneficiaries present process dialysis when sufferers acquired routine care from main care physicians.
“Representing just one% of the inhabitants, beneficiaries with kidney failure on long-term dialysis nonetheless account for greater than 7% of Medicare’s conventional fee-for-service spending,” Vahakn B. Shahinian, MD, MS, and colleagues from the College of Michigan Ann Arbor wrote. “Notably, solely a minority of those prices are instantly attributable to provision of dialysis and dialysis-related medication … As a substitute, many of the expense of this inhabitants stems from the administration of a constellation of comorbidities (eg, diabetes mellitus, coronary heart failure) and related issues afflicting the standard long-term dialysis affected person.
“Whereas the prices of dialysis and dialysis-related medication are comparatively mounted, these associated to administration of comorbidities are extra variable, and probably amenable to efforts at value containment,” the researchers wrote.
Vahakn B. Shahinian
The ACOs concerned within the care of sufferers on dialysis within the examine have been a part of the Medicare Sharing Financial savings Program and in operation earlier than 2017. Care in such applications was directed by PCPs.
“It’s unclear … whether or not ACOs can be an applicable mannequin of take care of long-term dialysis beneficiaries,” the authors wrote. “On one hand, ACOs could also be an efficient mannequin given their deal with coordinated care, which might be anticipated to be relevant to long-term dialysis beneficiaries who usually have a number of comorbidities for which they’re steadily hospitalized.”
They added, “Then again, PCPs could lack specialised data and expertise in caring for the medical problems with long-term dialysis beneficiaries or could duplicate care supplied by nephrologists who already essentially observe such beneficiaries recurrently. This will likely lead to care inefficiencies, probably resulting in elevated spending.”
The researchers analyzed nationwide Medicare claims information from a 20% random pattern of beneficiaries who acquired dialysis earlier than 2017. In the course of the examine, 135,152 sufferers on dialysis have been recognized. Value evaluation was based mostly on spending on Medicare Half A and Half B affected person providers.
In the course of the examine interval from 2012 to 2016, the p.c of long-term sufferers on dialysis who have been assigned to an ACO elevated from 6% to 23%.
“Within the time sequence evaluation, spending on ACO-aligned beneficiaries was $143 (95% CI $5 to $282) much less per beneficiary-quarter than spending for non-aligned beneficiaries,” the researchers wrote. “In analyses stratified by whether or not beneficiaries acquired care by a [PCP], financial savings by ACO-aligned beneficiaries have been restricted to these with care by a PCP ($235, 95% CI $73 to $397).”
The financial savings produced by the ACOs have been “comparatively modest,” the researchers acknowledged. “There are newer applications directed particularly at this group of sufferers, together with the Finish-Stage Renal Illness Seamless Care Group, or ESCO, program began in October 2015 and the upcoming Advancing American Kidney Well being initiative,” Shahinian and colleagues stated in a press launch summarizing the examine. “Our examine checked out an older and extra normal program, the Medicare Shared Financial savings Program ACOs, which began in 2012 and have been directed to the Medicare inhabitants typically. In future work, it is going to be of curiosity to see if the newer, extra kidney disease-specific applications will do even higher than the ACO applications have been in a position to obtain.”
In an accompanying editorial, authors Ahmed Awan, MD, and Kevin F. Erickson, MD, MS, agreed that the potential for financial savings would enhance with newer fee fashions launched over the past decade, noting “one cause why financial savings amongst ACO beneficiaries receiving long-term dialysis are small — or nonexistent — could also be as a result of many ACOs don’t focus particularly on sufferers with end-stage kidney illness … well being care suppliers collaborating in ACOs might want to establish methods to include ESKD care of their broader continual care administration applications.”
Awan A, et al. Clin Jrnl Am Soc Neph. 2020;doi:10.2215/CJN.16521020
Bakre S, et al. Clin Jrnl Am Soc Neph. 2020;doi:10.2215/CJN.02150220
— to www.healio.com