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The American Journal of Accountable Care March 2018
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Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings
David B. Muhlestein, PhD, JD; Spencer Q. Morrison, BA; Robert S. Saunders, PhD; William K. Bleser, PhD, MSPH; Mark B. McClellan, MD, PhD; and Lia D. Winfield, PhD
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Carey C. Thomson, MD, MPH; Nathalie Bloch, MD, MPA; Tafadzwa Muguwe, MD, MS; Kendell Clement, PhD; Shani Legore, BA; Orissa Viza, MSW, MPH; Joanne Kerwin, PhD; and Valerie E. Stone, MD, MPH
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Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated With Savings

David B. Muhlestein, PhD, JD; Spencer Q. Morrison, BA; Robert S. Saunders, PhD; William K. Bleser, PhD, MSPH; Mark B. McClellan, MD, PhD; and Lia D. Winfield, PhD
From 2013 to 2016, successful Medicare Shared Savings Program accountable care organizations reduced spending by shifting expenditures from the inpatient and postacute care setting to the physician office setting.
ABSTRACT

Objectives: To examine whether Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) changed their expenditure patterns from 2013 to 2016 and whether those changes were associated with reduced spending.

Study Design: Fixed-effects regression model to assess changing expenditures over time and the effect of expenditures on savings rate. Multiple sensitivity analyses were conducted to ensure consistent results.

Methods: MSSP public use files were the source of the data.

Results: MSSP ACOs that achieved financial savings were associated with less spending on inpatient and skilled nursing facility care and more spending on physician services. On average, MSSP ACOs reduced expenditures on inpatient care, postacute care, ambulatory services, hospice care, and durable medical equipment, and they increased expenditures on care provided in the physician office setting.

Conclusions: Our findings suggest that ACOs may be able to achieve savings by reapportioning resources to different sites of care. Further research is needed to determine how ACOs are able to shift their expenditures.

The American Journal of Accountable Care. 2018;6(1):11-19

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