TY - JOUR
T1 - Effect of Accountable Care Organizations on Emergency Medicine Payment and Care Redesign
T2 - A Qualitative Study
AU - Lin, Michelle P.
AU - Revette, Anna
AU - Carr, Brendan G.
AU - Richardson, Lynne D.
AU - Wiler, Jennifer L.
AU - Schuur, Jeremiah D.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was funded by a Health Policy Research grant from the Emergency Medicine Foundation (Drs. Lin and Schuur). Dr. Carr serves as director of the Emergency Care Coordination Center in the US Department of Health and Human Services. He has also received legal consulting fees. Dr. Wiler has received royalty payments from AgileMD and CareThrough. She serves as an appointed member of the Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee. Dr. Schuur has received legal consulting fees. Author contributions: MPL and JDS conceived the study, designed the trial, obtained research funding, supervised the conduct of the trial and data collection, undertook recruitment of participating centers and patients, and managed the data, including quality control. MPL, AR, and JDS analyzed the data. BGC, LDR, and JLW reviewed the study instruments and the results of the analysis. MPL drafted the article, and all authors contributed substantially to its revision. MPL takes responsibility for the paper as a whole.
Publisher Copyright:
© 2019 American College of Emergency Physicians
PY - 2020/5
Y1 - 2020/5
N2 - Study objective: Accountable care organizations are provider networks aiming to improve quality while reducing costs for populations. It is unknown how value-based care within accountable care organizations affects emergency medicine care delivery and payment. Our objective was to describe how accountable care has impacted emergency care redesign and payment. Methods: We performed a qualitative study of accountable care organizations, consisting of semistructured interviews with emergency department (ED) and accountable care organization leaders responsible for strategy, care redesign, and payment. We analyzed transcripts for key themes, using thematic analysis techniques. Results: We performed 22 interviews across 7 accountable care organizations. All sites were enrolled in the Medicare Shared Savings Program; however, sites varied in region and maturity with respect to population health initiatives. Nearly all sites were focused on reducing low-value ED visits, expanding alternate venues for acute unscheduled care, and redesigning care to reduce ED admission rates through expanded care coordination, including programs targeting high-risk populations such as older adults and frequent ED users, telehealth, and expanded use of direct transfer to skilled nursing facilities from the ED. However, there has been no significant reform of payment for emergency medical care within these accountable care organizations. Nearly all informants expressed concern in regard to reduced ED reimbursement, given accountable care organization efforts to reduce ED utilization and increase clinician participation in alternative payment contracts. No participants expressed a clear vision for reforming payment for ED services. Conclusion: Care redesign within accountable care organizations has focused on outpatient access and alternatives to hospitalization. However, there has been little influence on emergency medicine payment, which remains fee for service. Evidence-based policy solutions are urgently needed to inform the adoption of value-based payment for acute unscheduled care.
AB - Study objective: Accountable care organizations are provider networks aiming to improve quality while reducing costs for populations. It is unknown how value-based care within accountable care organizations affects emergency medicine care delivery and payment. Our objective was to describe how accountable care has impacted emergency care redesign and payment. Methods: We performed a qualitative study of accountable care organizations, consisting of semistructured interviews with emergency department (ED) and accountable care organization leaders responsible for strategy, care redesign, and payment. We analyzed transcripts for key themes, using thematic analysis techniques. Results: We performed 22 interviews across 7 accountable care organizations. All sites were enrolled in the Medicare Shared Savings Program; however, sites varied in region and maturity with respect to population health initiatives. Nearly all sites were focused on reducing low-value ED visits, expanding alternate venues for acute unscheduled care, and redesigning care to reduce ED admission rates through expanded care coordination, including programs targeting high-risk populations such as older adults and frequent ED users, telehealth, and expanded use of direct transfer to skilled nursing facilities from the ED. However, there has been no significant reform of payment for emergency medical care within these accountable care organizations. Nearly all informants expressed concern in regard to reduced ED reimbursement, given accountable care organization efforts to reduce ED utilization and increase clinician participation in alternative payment contracts. No participants expressed a clear vision for reforming payment for ED services. Conclusion: Care redesign within accountable care organizations has focused on outpatient access and alternatives to hospitalization. However, there has been little influence on emergency medicine payment, which remains fee for service. Evidence-based policy solutions are urgently needed to inform the adoption of value-based payment for acute unscheduled care.
UR - http://www.scopus.com/inward/record.url?scp=85078601461&partnerID=8YFLogxK
U2 - 10.1016/j.annemergmed.2019.09.010
DO - 10.1016/j.annemergmed.2019.09.010
M3 - Article
C2 - 31973914
AN - SCOPUS:85078601461
SN - 0196-0644
VL - 75
SP - 597
EP - 608
JO - Annals of Emergency Medicine
JF - Annals of Emergency Medicine
IS - 5
ER -