{"title":"基准如何影响问责制医疗组织的参与:自愿支付模式的前景","authors":"Alice J Chen, J Michael McWilliams","doi":"10.1086/726748","DOIUrl":null,"url":null,"abstract":"<p><p>In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.</p>","PeriodicalId":45056,"journal":{"name":"American Journal of Health Economics","volume":" ","pages":"38-62"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393041/pdf/","citationCount":"0","resultStr":"{\"title\":\"How Benchmark Changes Affect Participation in Accountable Care Organizations: Prospects for Voluntary Payment Models.\",\"authors\":\"Alice J Chen, J Michael McWilliams\",\"doi\":\"10.1086/726748\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.</p>\",\"PeriodicalId\":45056,\"journal\":{\"name\":\"American Journal of Health Economics\",\"volume\":\" \",\"pages\":\"38-62\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12393041/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Health Economics\",\"FirstCategoryId\":\"96\",\"ListUrlMain\":\"https://doi.org/10.1086/726748\",\"RegionNum\":2,\"RegionCategory\":\"经济学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ECONOMICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Health Economics","FirstCategoryId":"96","ListUrlMain":"https://doi.org/10.1086/726748","RegionNum":2,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
How Benchmark Changes Affect Participation in Accountable Care Organizations: Prospects for Voluntary Payment Models.
In voluntary alternative payment models, participation is essential for model viability and the progression of provider payment reform. We study participation decisions of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). We leverage a natural experiment in which a 2017 rule change introduced differential shocks to an ACO's baseline spending and performance-year spending. The net effect was an effective change in benchmarks that varied across ACOs. Dropout was 7 percentage points more likely among ACOs with effective benchmark decreases. While small reductions in the effective benchmark did not affect program participation, larger reductions increased dropout by 11 percentage points. ACOs with spending already above their benchmarks were particularly sensitive to effective benchmark reductions, consistent with the program's weak long-term incentives to reduce spending. Our results highlight the causal role benchmarks play in determining ACO participation and the need to consider the consequences of participation effects in the design of new payment models.
期刊介绍:
The American Journal of Health Economics (AJHE) provides a forum for the in-depth analysis of health care markets and individual health behaviors. The articles appearing in AJHE are authored by scholars from universities, private research organizations, government, and industry. Subjects of interest include competition among private insurers, hospitals, and physicians; impacts of public insurance programs, including the Affordable Care Act; pharmaceutical innovation and regulation; medical device supply; the rise of obesity and its consequences; the influence and growth of aging populations; and much more.