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Accountable care organizations offer no significant reduction in cancer treatment costs
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Patients with cancer did not have significant reductions in treatment costs or health care use when treated by physicians at accountable care organizations compared to those treated by non-ACOs, according to a study of Medicare claims published in Journal of Clinical Oncology.
“Although it may be too early to see an impact of ACOs on patients with cancer, it is also possible that ACOs may need to explicitly focus on patients with cancer to improve their care and reduce unnecessary spending,” Miranda B. Lam, MD, MBA, instructor in radiation oncology at Harvard Medical School, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, and colleagues wrote.
ACOs represent a model in which a group of health care providers is collectively responsible for the cost and quality of care for a patient population.
The researchers described ACOs as “arguably the most important national experiment to control health care spending,” but whether ACOs affected care of patients with cancer was unknown.
“Given their incentive to reduce costs, one might surmise that ACOs have made changes to care of patients with cancer to reduce unnecessary hospitalizations or marginally effective therapies,” Lam and colleagues wrote. “Critics of ACOs may worry that these incentives might lead to skimping on needed costly therapies that are potentially beneficial.”
Researchers focused on spending patterns for providers that became ACOs, whether spending patterns changed for specific types of cancer, and how spending varied for specific services such as inpatient hospitalization and chemotherapy.
Researchers used 2011 to 2015 Medicare data to identify practices that became ACOs, which they matched with non-ACO practices within the same geographic region. These practices represented 388,784 ACO patients (mean age, 76.7 years; 87.7% white) and 233,296 non-ACO patients (mean age 76.9 years, 87.4% white), who were comparable in terms of age, race, sex, dual eligibility status and comorbidities.
Researchers calculated spending per beneficiary, as well as spending for and use of EDs, inpatient admissions, hospice, chemotherapy and radiation therapy.
Total mean spending per beneficiary in the pre-ACO period was $18,909 for ACOs and $18,458 for non-ACOs.
Researchers observed a significant decrease in spending from pre-ACO to post-ACO among both ACO patients and non-ACO patients. However, the difference-in-difference analysis showed that the decrease among ACO patients ($18,909 vs. $18,601; –$308) was not significantly different compared with the decrease among non-ACO patients ($18,458 vs. $18,139; –$319), based on an $11 difference (95% CI, 275 to 297).
Researchers observed no significant changes in spending for any specific cancer diagnoses or for any cancer-specific services.
Limitations of the study included not being able to incorporate more detailed data on cancer stage and diagnosis date, and that ACO participation is voluntary, which made spending comparisons difficult. Lam and colleagues were also unable to distinguish between ACOs that were targeting cancer care vs. those that were not.
“These findings have important implications,” Lam and colleagues wrote. “First, our study should reset our expectations about whether the current generation of ACOs will have much impact on cancer care, at least over the short term. Whether other promising payment models under consideration, such as the oncology medical home model, are likely to be better at reducing unnecessary spending or improving outcomes is unclear.” – by Trudi Gilfillian
Disclosures: Lam reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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