By Andrew M. Seaman
NEW YORK (Reuters Health) - Large independent doctor practices that focus on primary care tend to spend less money and are more likely to meet guidelines for Americans on Medicare than smaller groups, according to a new study.
The findings suggest that the so-called Accountable Care Organizations (ACO) created by the 2010 Affordable Care Act may improve the quality of care while lowering spending, said the study's lead author.
"I think our analysis is sort of searching for pockets of excellence and seeing whether those pockets of excellence echo the ACOs. We found they do," said Dr. J. Michael McWilliams from the Harvard Medical School in Boston, whose team published its results in JAMA Internal Medicine.
ACOs are newly created groups of doctors and healthcare providers who are responsible for the care of people on Medicare, the U.S. insurance program for the elderly and disabled. ACOs are typically paid based on the quality of care they provide.
For the new study, the researchers linked data from about 4.3 million people on Medicare in 2009 to information on the number of patients their doctor's practice managed care for. The researchers then compared hospital-based doctor groups and large- and medium-sized independent practices to small doctor groups.
Overall, hospital-based practices spent $12,181 per Medicare patient compared to small practices, which spent $11,332 per patient. Large and medium independent practices spent the least - about $11,275 per patient.
The researchers also found large- and medium-sized groups spent even less money when they took on more financial risks, such as the possibility that they'd overspend and have to repay the insurers.
Those large and medium groups were also slightly more likely than smaller groups to meet care guidelines along with measures typically used to judge quality.
For example, they did modestly better when it came to screening their patients for high cholesterol, diabetes and breast cancer than the smaller groups.
Large- and medium-sized practices also had about the same hospital readmission rate as small practices with about 16 percent of their patients going back to the hospital within 30 days of being released.
Hospital-based doctor practices had the worst hospital readmission rate - about 17 percent.
What's more, the researchers found groups with a large number of primary care doctors preformed the best.
"No matter the type of organization, primary care orientation was associated with better quality and lower spending relative to smaller practices," said McWilliams.
‘MORE SOPHISTICATED AND BETTER'
"The article gave me some hope for ACO models," said Carrie Colla, who has studied healthcare delivery structures but was not involved with the new study.
However, Colla, from The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine in Hanover, New Hampshire, said, "We have no evidence to tell us how those types of practices will do under risk-bearing scenarios."
In a commentary accompanying the new study, Dr. Arnold Epstein from the Harvard School of Public Health in Boston suggested the new results should be seen as a baseline to measure the future success of ACOs.
McWilliams told Reuters Health that he's optimistic if people do view their results as a starting point, because ACOs are supposed to be better than current systems.
"Ten years down the road, the ideal would be for ACOs to be far more sophisticated and better at providing care than any organization that's already out there," he said.
SOURCE: http://bit.ly/15ggfsi JAMA Internal Medicine, online June 17, 2013.