CMS and other groups have a lot riding on the accountable care organization concept. CMS’ early experience has not been particularly positive and a number of organizations have dropped out of the program for Medicare beneficiaries. While the biggest hope for ACOs is that they will reduce growth in health spending, many believe they will also improve quality and outcomes. One aspect of quality is patient satisfaction or the patient experience of care processes. A New England Journal article reports on a study of patient experience of care in Medicare ACOs. (NEJM Article) A portion of the savings which the Medicare ACOs can attain is dependent on performance on quality measures, including patient satisfaction, so they should be attentive to this dimension of care. Using the Medicare standard patient satisfaction survey results, the authors compared the scores of patients in ACOs in 2012 with those served by providers outside the ACO program. One limitation of the study is that Medicare does not require beneficiaries to enroll in an ACO but “attributes” them to ACOs who have enrolled in the program and who serve as the primary source of care for the beneficiary.
The primary areas which were rated by patients were overall care, interaction with primary care physician, timeliness of care and care coordination. High-risk beneficiaries were examined as a subgroup. Various adjustments were made to the analyses to eliminate potential bias or confounders. Prior to the intervention period (2012) patient ratings of experience of care were similar in the ACO group and the control group of non-ACO participating providers. Overall care ratings of care and ratings for interaction with primary care doctors did not change between the intervention and control group. Ratings for timely access to care and for some of the items contained in the care coordination domain did show greater improvement in the ACO group. For patients with high health needs, the ratings of overall care did show more improvement. While the research has limitations, it suggests that ACOs can improve the experience of care, particularly for those patients who use the health system most.