Family Practices in Transforming Clinical Practice Initiative Showed No Changes in Medicare Costs or Utilization.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
6
11
2021
medline:
21
12
2021
entrez:
5
11
2021
Statut:
ppublish
Résumé
The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019. The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative. A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample. A total of 761 PTN practices and 3451 non-PTN practices. To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics. The differences in Medicare Part A and B costs (-1.71%, P=0.25), annual rates of hospitalization (-0.59%, P=0.12) and emergency department visit (-0.29%, P=0.46) were not significantly lower among PTN practices (N=761) than among propensity score-matched non-PTN practices (N=3541). TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.
Sections du résumé
BACKGROUND
The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019.
OBJECTIVE
The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative.
STUDY DESIGN
A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample.
SUBJECTS
A total of 761 PTN practices and 3451 non-PTN practices.
MEASURES
To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics.
RESULTS
The differences in Medicare Part A and B costs (-1.71%, P=0.25), annual rates of hospitalization (-0.59%, P=0.12) and emergency department visit (-0.29%, P=0.46) were not significantly lower among PTN practices (N=761) than among propensity score-matched non-PTN practices (N=3541).
CONCLUSIONS
TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.
Identifiants
pubmed: 34739412
doi: 10.1097/MLR.0000000000001662
pii: 00005650-202201000-00008
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
50-55Subventions
Organisme : Centers for Medicare and Medicaid Services
ID : 1L1CMS331473
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Centers for Medicare & Medicaid Services. The Hospital Value-Based Purchasing (VBP) Program. 2021. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing . Accessed October 20, 2021.
Centers for Medicare & Medicaid Services. Accountable Care Organizations (ACOs). 2021. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO . Accessed October 20, 2021.
Centers for Medicare & Medicaid Services. Transforming Clinical Practice Initiative Awards; 2015. Available at: www.cms.gov/newsroom/fact-sheets/transforming-clinical-practice-initiative-awards . Accessed September 24, 2019.
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