por Gus Iversen
, Editor in Chief | September 23, 2016
While everyone seems to agree that outcome-based reimbursement is a better concept than fee for service, researchers from the Harvey L. Neiman Health Policy Institute believe there is a "lack of mathematical models that can comprehensively capture and efficiently analyze the complex, multi-level interactions" behind the curtain of the tidy value-based concept.
So they crunched the numbers to figure out how ACOs (and their reimbursement models) impact the cost, quality, utilization and technological investment for radiology practices.
Their study — published in collaboration with industrial engineers from Virginia Tech and available online in the journal Health Care Management Science
— specifically explores CT utilization under the Medicare Shared Savings Program (MSSP) for ACOs.
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What they found was that provider participation in ACOs occurs at a wide range of cost benchmarks, which in turn result in a wide range of physician provider shares.
"In choosing a cost benchmark, CMS needs to consider the willingness of the ACO and its members to participate in the MSSP program," Hui Zhang, one of the researchers, told HCB News. "Different agents, such as hospitals, primary care physicians, and radiologists may have different thresholds of cost benchmarks in order to be willing to participate."
These variances are important in part, they found, because provider shares and cost thresholds impact utilization of services and, by extension, patient health. In addition, MSSP incentives reduce the attractiveness of a CT scanner investment for hospitals, said Zhang.
While discouraging investment in new technology may not be a desirable outcome by some standards, that frugality also yields some clear benefits.
"The theoretical findings from our paper confirmed that MSSP incentives can reduce the number of CT tests ordered by primary care physicians and radiologists," she said. "MSSP is an effective mechanism to address CT scan overuse that stems from fee for service payments.
“Our health care system is so complex that it is difficult to foresee the consequences of proposed policies and organizational changes,” said Christian Wernz, Ph.D., a Neiman Institute grantee and assistant professor of industrial and systems engineering at Virginia Tech, in a statement. “Our research aims to provide policy makers, payors and hospital executives with decision support that is based on rigorous, evidence-based analyses. Our ultimate goal is to find ways to improve health outcomes for patients while lowering costs.”
The researchers speculate that their findings would not be unique to MSSP participants but would apply to radiology practices utilizing other alternative payment model arrangements.
“Perhaps, as others have said, the unintended consequences of these programs are related to the volume of APM programs available – causing providers to question these programs’ permanence and not really change their behaviors," said Danny R. Hughes, Ph.D., Neiman Institute senior director for health policy research and senior research fellow. "However, it’s always possible, as we learn from ACO SSPs that at least some of these consequences may be built into the program’s incentive structures themselves.”
For Zhang, the value of her team's research is in providing decision-making insights and policy insights for providers on MSSP — including how to optimally invest in and utilize CT imaging technology as well as how to distribute MSSP incentives among ACO members.