Pioneer ACO program shown to have success reducing low-value services

The Medicare Pioneer accountable care organization (ACO) program has the ability to modestly reduce low-value services, including imaging-related services, according to a recent study published by JAMA Internal Medicine.

A reflection of the healthcare-wide push to maximize value, the Pioneer ACO program creates a budget and providers in the program are given incentives to stay under that budget while improving quality measures.

J. Michael McWilliams, MD, PhD, of the Harvard Medical School department of health care policy, and colleagues studied the effects of this strategy, comparing the use of low-value services by Medicare fee-for-service beneficiaries who belong to providers in the Pioneer ACO program with use by beneficiaries not in the program. Data was examined from before 2012, when the program went into effect, and after.

The team focused on 31 low-value services from a variety of specialties. The services were broken down into six categories: imaging, cancer screening, diagnostic and preventive testing, preoperative testing, cardiovascular testing and procedures, and other invasive procedures.

Overall, McWilliams and colleagues found the first year of ACO contracts was associated with a differential reduction of 0.8 low-value services for every 100 beneficiaries. This equaled a 1.9 percent differential reduction in service quantity.

Of the 31 low-value services studied, those specific to imaging included: CT of the sinuses for uncomplicated acute rhinosinusitis, head imaging in the evaluation of syncope, head imaging for uncomplicated headache, electroencephalogram (EEG) for headaches, back imaging for patients with nonspecific low back pain, screening for carotid artery disease in asymptomatic adults, and imaging for diagnosis of plantar fasciitis.

Looking specifically at those services, the first year of ACO contracts was associated with a differential reduction of 0.3 low-value imaging services for every 100 beneficiaries. This equaled a 1.8 percent differential reduction in low-value imaging service quantity.

“Our findings, taken together with those of studies demonstrating spending reductions greater than Medicare bonus payments and improved or stable performance on measures of patient experiences and quality, are consistent with the conclusion that the overall value of health care provided by Pioneer ACOs improved after their participation in an alternative payment model,” the authors wrote.

A commentary by Arnold Milstein, MD, of Stanford University, accompanied the article in JAMA Internal Medicine. Milstein touched on how the Pioneer ACO program, and other similar programs, will only grow as time goes on.

“Uniquely positioned to slow health care spending growth responsibly, physicians and other health care professionals at the initiation of Medicare’s Pioneer ACO program precisely targeted reduction of low-value services,” Milstein wrote. “All physicians and health care managers will increasingly be called on to apply similar precision in continuously lowering the unit cost of delivering valuable services without impairing the quality of care. Although adjusting practice to lower costs is a stretch from physicians’ traditional role, the well-being of their patients and their communities now depend on it.”