Timothy T. Cuerdon

Association of Pioneer Accountable Care Organizations vs Traditional Medicare Fee for Service With Spending, Utilization, and Patient Experience

IMPORTANCE The Pioneer Accountable Care Organization (ACO) Model aims to drive health care organizations to reduce expenditures while improving quality for fee-for-service (FFS) Medicare beneficiaries. OBJECTIVE To determine whether FFS beneficiaries aligned with Pioneer ACOs had smaller increases in spending and utilization than other FFS beneficiaries while retaining similar levels of care satisfaction in the first 2 years of the Pioneer ACO Model. DESIGN, SETTING, AND PARTICIPANTS Participants were FFS Medicare beneficiaries aligned with 32 ACOs (n = 675,712 in 2012; n = 806,258 in 2013) and a comparison group of alignment-eligible beneficiaries in the same markets (n = 13,203,694 in 2012; n = 12,134,154 in 2013). Analyses comprised difference-in-differences multivariable regression with Oaxaca-Blinder reweighting to model expenditure and utilization outcomes over a 2-year performance period (2012-2013) and 2-year baseline period (2010-2011) as well as adjusted analyses of Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey responses among random samples of beneficiaries in Pioneer ACOs (n = 13,097), FFS (n = 116,255), or Medicare Advantage (n = 203,736) for 2012 care. EXPOSURES Beneficiary alignment with a Pioneer ACO in 2012 or 2013. MAIN OUTCOMES AND MEASURES Medicare spending, utilization, and CAHPS domain scores. RESULTS Total spending for beneficiaries aligned with Pioneer ACOs in 2012 or 2013 increased from baseline to a lesser degree relative to comparison populations. Differential changes in spending were approximately -

Frequency of variable measurement in 16 pediatric intensive care units : influence on accuracy and potential for bias in severity of illness assessment

35.62 (95% CI, -

LIMITATIONS AND WITHDRAWAL OF MEDICAL INTERVENTIONS IN PEDIATRIC CRITICAL CARE

40.12 to -

Quality of Medical Care Delivered to Medicare Beneficiaries: A Profile at State and National Levels

31.12) per-beneficiary-per-month (PBPM) in 2012 and -

Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001.

11.18 (95% CI, -

Impact of Quality-of-Care Factors on Pediatric Intensive Care Unit Mortality

15.84 to -

Physician burnout in pediatric critical care medicine

6.51) PBPM in 2013, which amounted to aggregate reductions in increases of approximately -

Outcomes of children in a persistent vegetative state

280 (95% CI, -

PEDIATRIC CRITICAL CARE AS A CAREER

315 to -

Liability for Adverse Events in Direct-to-Consumer Advertising—Reply

244) million in 2012 and -