Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_39_2977 - End of Life Spending Among Cancer Patients in an ACO vs. non-ACO

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

End of Life Spending Among Cancer Patients in an ACO vs. non-ACO
M. Lam1,2, J. Figueroa2, K. Reimold2, E. J. Orav3, and A. Jha2; 1Brigham and Women's Hospital / Dana Farber Cancer Institute, Boston, MA, 2Harvard T.H. Chan School of Public Health, Boston, MA, 3Brigham and Women's Hospital, Boston, MA

Purpose/Objective(s): Nearly 25% of the annual Medicare budget is devoted to care of beneficiaries who die in a given year. Therefore, there has been increased policy and provider focus on understanding the care provided to patients at the end of life. Of the many initiatives aimed at improving the value of healthcare services in the United States, Accountable Care Organizations (ACOs) are receiving substantial policy attention. Early evidence shows modest reductions in total healthcare costs for Medicare beneficiaries. However, we are unaware of any data looking specifically at the impact of ACOs on spending for patients with cancer, specifically at the end of life.

Materials/Methods: We analyzed a 20% sample of Medicare beneficiaries age 66 years or older. We followed CMS public guidelines to attribute each patient to an ACO or non-ACO practice. Using ICD-9 codes, we identified patients with malignancies of the following types: lung, hematologic, gastrointestinal, breast, genitourinary, head and neck, sarcoma, melanoma, central nervous system, and metastatic disease of unknown primary. We matched ACO and non-ACO practices within the same HRR using propensity score matching. We then narrowed the population to patients who died in 2013 or 2014. We identified beneficiary age, race, sex, dual-eligibility status, and chronic conditions as covariates. We calculated mean annual standardized total costs in the 180 days prior to death as well as stratified by the following categories of spending: inpatient, outpatient, physician, skilled nursing facility, home health, hospice, radiation oncology, and chemotherapy. Spending was adjusted for patient characteristics and by chronic conditions, using the Chronic Conditions Warehouse.

Results: In our sample of patients who died in 2013 and 2014, 36% of patients were in an ACO. ACO and non-ACO patients were similar in terms of patient characteristics (age, race, sex, dual eligibility, and comorbidities). ACO beneficiaries had modest but significantly higher total annual standardized costs compared to beneficiaries not in an ACO ($47,629 vs. $45,582; p=0.02). The ACO and non-ACO patients had similar spending by categories: inpatient ($23,908 vs. $22,843; p=0.06), outpatient ($4,939 vs. $4,403; p=0.09), physician services ($13,412 vs. $12,975; p=0.26), SNF ($2,164 vs. $1,952; p=0.18), HHA ($2,009 vs. $2,027; p=0.82), hospice ($683 vs. $793; p=0.07), radiation oncology ($449 vs. $422; p=0.62), and chemotherapy ($1,927 vs. $1,813; p=0.57).

Conclusion: Spending in the last 6 months of life among cancer patients treated in an ACO was slightly higher compared to those not treated in an ACO. This study suggests that ACOs have not had a meaningful impact in reducing costs at the end of life for cancer patients.

Author Disclosure: M. Lam: None. J. Figueroa: None. K. Reimold: None. E.J. Orav: None.

Miranda Lam, MD, MBA

Brigham & Women's Hospital

Disclosure:
No relationships to disclose.

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