Low-Value Care and Clinician Engagement in a Large Medicare Shared Savings Program ACO: a Survey of Frontline Clinicians
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University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA; 3Department of Health Management and Policy, Saint Louis University, St. Louis, MO, USA; 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; 5Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 6Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA; 7Department of Economics, University of Michigan, Ann Arbor, MI, USA; 8National Bureau of Economic Research, Cambridge, MA, USA; 9Physician Organization of Michigan Accountable Care Organization, Ann Arbor, MI, USA; 10Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; 11Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.
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 Prior Presentations An earlier version of this article was presented at the American Society of Health Economists Annual Meeting, Washington, DC, June 2019, and the AcademyHealth Annual Research Meeting, Washington, DC, June 2019. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05511-8) contains supplementary material, which is available to authorized users. Received September 18, 2018 Revised June 3, 2019 Accepted October 1, 2019
care coordination (17%) or inappropriate care (13%). Clinicians reported they had difficulty following recommendations against low-value care 18%
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