Medicare ACOs With Cardiologists Save Money

ACOs with cardiologists may see lower spending for SNFs, ED visits, evaluation and management services and procedural care.

Medicare accountable care organizations that have cardiologists in their physician network save about $200 per patient per year when compared with ACOs that don't, new research shows.

Study senior author John Hollingsworth, MD, a urologist at Michigan Medicine, speculated that that the $200 annual savings in the ACOs with cardiologists was a result of lower spending for skilled nursing facilities, evaluation and management services and procedural care. 

"While the mechanism is unclear, we speculate that ACOs with cardiologists may be more likely to develop efficient, appropriate, and value-centered referral pathways," Hollingsworth said in an email exchange with HealthLeaders.

The Agency for Healthcare Research and Quality-funded study looked at Medicare data for 1.6 million patients per year with cardiovascular disease, including heart attacks, atrial fibrillation, congestive heart failure and ischemic heart disease.

Although the number of ACOs more than tripled–from 114 in 2012 to 392 in 2015–from 2012 through 2015, the proportion of ACOs with cardiologist participation remained at 80% in 2012 to 83% in 2015.

Outcomes for heart failure admission rates, ED visits and hospital readmissions were the same between the two ACO models.

"We try to disentangle whether the reduced spending is related to cardiologist participation or other unmeasured characteristics of ACOs and find evidence to suggest the former," Hollingsworth said.

"For instance, in some practices, a new diagnosis of atrial fibrillation may lead to costly ED visits or hospitalizations, whereas in other practices it may be managed safely and effectively as an outpatient with expedited cardiology outpatient follow-up," he said.

The study was recently published in Circulation: Cardiovascular Quality and Outcomes.