Adam A Markovitz1,2, Michael D Rozier3, Andrew M Ryan2,4, Susan D Goold2,4,5, John Z Ayanian2,4,5,6, Edward C Norton2,4,7,8, Timothy A Peterson9,10, John M Hollingsworth11,12. 1. University of Michigan Medical School, Ann Arbor, MI, USA. 2. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA. 3. Department of Health Management and Policy, Saint Louis University, St. Louis, MO, USA. 4. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 5. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 6. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA. 7. Department of Economics, University of Michigan, Ann Arbor, MI, USA. 8. National Bureau of Economic Research, Cambridge, MA, USA. 9. Physician Organization of Michigan Accountable Care Organization, Ann Arbor, MI, USA. 10. Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 11. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. kinks@med.umich.edu. 12. Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA. kinks@med.umich.edu.
Abstract
BACKGROUND: Although the Medicare Shared Savings Program (MSSP) created new incentives for organizations to improve healthcare value, Accountable Care Organizations (ACOs) have achieved only modest reductions in the use of low-value care. OBJECTIVE: To assess ACO engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. DESIGN: Cross-sectional survey of ACO clinicians in 2018. PARTICIPANTS: 1289 clinicians in the Physician Organization of Michigan ACO, including generalist physicians (18%), internal medicine specialists (16%), surgeons (10%), other physician specialists (27%), and advanced practice providers (29%). Response rate was 34%. MAIN MEASURES: Primary exposures included clinicians' participation in ACO decision-making, awareness of ACO incentives, perceived influence on practice, and perceived quality improvement. Our primary outcome was clinicians' reported difficulty implementing recommendations against low-value care. RESULTS: Few clinicians participated in the decision to join the ACO (3%). Few clinicians were aware of ACO incentives, including knowing the ACO was accountable for both spending and quality (23%), successfully lowered spending (9%), or faced upside risk only (3%). Few agreed (moderately or strongly) the ACO changed compensation (20%), practice (19%), or feedback (15%) or that it improved care coordination (17%) or inappropriate care (13%). Clinicians reported they had difficulty following recommendations against low-value care 18% of the time; clinicians reported patients had difficulty accepting recommendations 36% of the time. Increased ACO awareness (1 standard deviation [SD]) was associated with decreased difficulty (- 2.3 percentage points) implementing recommendations (95% confidence interval [CI] - 3.8, - 0.7), as was perceived quality improvement (1 SD increase, - 2.1 percentage points, 95% CI, - 3.4, - 0.8). Participation in ACO decision-making and perceived influence on practice were not associated with recommendation implementation. CONCLUSIONS: Clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
BACKGROUND: Although the Medicare Shared Savings Program (MSSP) created new incentives for organizations to improve healthcare value, Accountable Care Organizations (ACOs) have achieved only modest reductions in the use of low-value care. OBJECTIVE: To assess ACO engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. DESIGN: Cross-sectional survey of ACO clinicians in 2018. PARTICIPANTS: 1289 clinicians in the Physician Organization of Michigan ACO, including generalist physicians (18%), internal medicine specialists (16%), surgeons (10%), other physician specialists (27%), and advanced practice providers (29%). Response rate was 34%. MAIN MEASURES: Primary exposures included clinicians' participation in ACO decision-making, awareness of ACO incentives, perceived influence on practice, and perceived quality improvement. Our primary outcome was clinicians' reported difficulty implementing recommendations against low-value care. RESULTS: Few clinicians participated in the decision to join the ACO (3%). Few clinicians were aware of ACO incentives, including knowing the ACO was accountable for both spending and quality (23%), successfully lowered spending (9%), or faced upside risk only (3%). Few agreed (moderately or strongly) the ACO changed compensation (20%), practice (19%), or feedback (15%) or that it improved care coordination (17%) or inappropriate care (13%). Clinicians reported they had difficulty following recommendations against low-value care 18% of the time; clinicians reported patients had difficulty accepting recommendations 36% of the time. Increased ACO awareness (1 standard deviation [SD]) was associated with decreased difficulty (- 2.3 percentage points) implementing recommendations (95% confidence interval [CI] - 3.8, - 0.7), as was perceived quality improvement (1 SD increase, - 2.1 percentage points, 95% CI, - 3.4, - 0.8). Participation in ACO decision-making and perceived influence on practice were not associated with recommendation implementation. CONCLUSIONS: Clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
Entities:
Keywords:
health policy; health services research; healthcare reform; stakeholder engagement; survey research
Authors: Adam A Markovitz; John M Hollingsworth; John Z Ayanian; Edward C Norton; Nicholas M Moloci; Phyllis L Yan; Andrew M Ryan Journal: Health Aff (Millwood) Date: 2019-02 Impact factor: 6.301
Authors: Michelle P Lin; David Muhlestein; Brendan G Carr; Lynne D Richardson; Jennifer L Wiler; Jeremiah D Schuur Journal: J Gen Intern Med Date: 2018-10 Impact factor: 5.128
Authors: Stephen M Shortell; Carrie H Colla; Valerie A Lewis; Elliott Fisher; Eric Kessell; Patricia Ramsay Journal: J Health Polit Policy Law Date: 2015-06-29 Impact factor: 2.265
Authors: John M Hollingsworth; Brahmajee K Nallamothu; Phyllis Yan; Sarah Ward; Sunny Lin; Carrie H Colla; Valerie A Lewis; John Z Ayanian; Brent K Hollenbeck; Andrew M Ryan Journal: Circ Cardiovasc Qual Outcomes Date: 2018-06
Authors: Robin Osborn; Donald Moulds; Eric C Schneider; Michelle M Doty; David Squires; Dana O Sarnak Journal: Health Aff (Millwood) Date: 2015-12 Impact factor: 6.301
Authors: Stephen M Shortell; Sean R McClellan; Patricia P Ramsay; Lawrence P Casalino; Andrew M Ryan; Kennon R Copeland Journal: Health Serv Res Date: 2014-03-15 Impact factor: 3.402
Authors: Andrew J Admon; Ashwin Gupta; Margaret Williams; Thomas S Valley; Michael W Sjoding; Renda Soylemez Wiener; Colin R Cooke Journal: J Hosp Med Date: 2018-04-25 Impact factor: 2.960
Authors: Robert J Trager; Brian R Anderson; Regina M Casselberry; Jaime A Perez; Jeffery A Dusek Journal: BMC Musculoskelet Disord Date: 2022-06-08 Impact factor: 2.562
Authors: Adam A Markovitz; Andrew M Ryan; Timothy A Peterson; Michael D Rozier; John Z Ayanian; John M Hollingsworth Journal: J Gen Intern Med Date: 2021-01-26 Impact factor: 5.128