Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs.

ABSTRACT: Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, we examined the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15. While there was no association between out-of-network specialty care and ACO spending, each percentage-point increase in receipt of out-of-network primary care was associated with an increase of $10.79 in quarterly total ACO spending per beneficiary. When we broke down total spending by place of service, we found that out-of-network primary care was associated with higher spending in outp

SUBMITTER: Lin SC 

PROVIDER: S-EPMC7213776 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature