Table 3.
Health care spending and quality for 2009 Medicare beneficiaries by provider group type
| Annual spending, utilization, or quality metric | Provider Group Type | |||
|---|---|---|---|---|
| Small groups (reference category) | Groups sufficiently large to participate in ACO programs | |||
| Medium-sized independent groups | Large independent groups | Hospital-based groups | ||
| Adjusted mean | Difference relative to reference category | Difference relative to reference category | Difference relative to reference category | |
| Total per-beneficiary medical spending, $ | 11,332 | −69 | −44§ | 849 |
| Spending by type of claim, $* | ||||
| Hospital facility | 3,722 | 22§ | 34§ | 455 |
| Physician/supplier | 3,441 | −100 | −168 | −29 |
| Hospital outpatient department | 2,285 | 29 | 52 | 355 |
| Skilled nursing facility | 751 | −21 | −1§ | 5§ |
| Spending on physician and ancillary services by BETOS category, $† | ||||
| Office visits | 643 | 1§ | 0§ | 39 |
| Specialty consultations | 286 | −3§ | −3§ | 1§ |
| Major procedures | 777 | −23 | −26 | 11§ |
| Minor and ambulatory procedures, endoscopy | 869 | −39 | −21 | 5§ |
| Imaging | 739 | −13 | −17 | 16 |
| Cardiac interventions and tests | 233 | −6 | −9 | 5 |
| Radiation therapy, chemotherapy and other Part B-covered drugs | 731 | 8§ | −17§ | 240 |
| Lab tests | 432 | −2§ | 0§ | 33 |
| Utilization, n | ||||
| Hospitalizations‡ | 0.37 | 0.00§ | 0.00§ | 0.02 |
| Physician office visits | 8.37 | −0.12 | −0.24 | −0.24 |
| Hospital outpatient department visits | 5.58 | 0.11 | 0.39 | 1.32 |
| Quality of Care, %¶ | ||||
| 30-day readmission | 16.1 | 0.3 | 0.3 | 1.3 |
| Screening mammography | 70.7 | 1.7 | 1.7 | 2.8 |
| Diabetes | ||||
| LDL cholesterol testing | 74.5 | 1.6 | 1.4 | −0.3§ |
| Hemoglobin A1c testing | 71.1 | 2.4 | 3.0 | 0.6 |
| Retinal exam | 73.6 | 0.7 | 1.1 | 0.3§ |
| All 3 services | 46.7 | 2.2 | 2.9 | 0.8 |
| Cardiovascular disease | ||||
| LDL cholesterol testing | 69.2 | 0.9 | 0.6 | −0.7 |
ACO = accountable care organization; BETOS = Berenson-Eggers Type of Service; LDL = low-density lipoprotein.
Does not include lesser contributions from spending on home health, durable medical equipment, and hospice care. Spending on physician/supplier services is totaled from the carrier claims file. Of note, hospital outpatient department spending (totaled from the outpatient file) contains some additional spending on physician services.
Includes claims for physician and ancillary (supplier) services appearing in the carrier file as well as claims for physician and ancillary services appearing in the hospital outpatient department claims file. Analyses of spending by BETOS categories were restricted to the 5% sample of Medicare beneficiaries, for whom we had both hospital outpatient department and carrier claims files. BETOS codes were grouped as follows: office visits (M1A-M1B); specialty consultations (M5A-M5D, M6); major procedures (P0, P4A-P4E, P1A-P3D except P2D); minor and ambulatory procedure and endoscopy (P5A-P5E, P6A-P6D, P8A-P8I); imaging (I1A-I1F, I2A-I2D, I3A-I3F); cardiac catheterization, testing, and imaging (I4A-I4B, P2D, T2A-T2D); radiation therapy, chemotherapy, and other drugs (P7A-P7B, O1D-O1E); lab tests (T1A-T1H).
Hospitalization counts exclude transfers.
Analyses of quality measures were restricted to the 5% sample of Medicare beneficiaries, for whom we had hospital outpatient department, inpatient facility, and carrier claims to assess receipt of key services. Readmissions were assessed among beneficiaries with at least one acute care hospitalization in 2009. We counted only one readmission per beneficiary annually in calculating 30-day readmission rates. Screening mammography was assessed among women ages 65–69 years. Diabetes services were assessed among beneficiaries with a history of diabetes prior to 2009. LDL testing for cardiovascular disease was assessed among beneficiaries with ischemic heart disease, history of myocardial infarction, or history of stroke or TIA present prior to 2009.
Denotes lack of statistically significant difference relative to reference category of small groups. All other estimates for potentially ACO-eligible group types differ significantly from small groups at least at the P<0.05 level.