The consequences of policy changes

You can call any change in public policy a natural experiment. This week we had a glimpse of some results.

Payers including Medicare see accountable care organizations (ACOs) as a mechanism for improving patient outcomes and lowering costs by coordinating care. Under this model, participants have incentives to weed out redundant tests, for instance, or unnecessary treatments and in return they share in the cost savings. They also are assessed on outcomes to ensure no one is shirking on care to save on costs.

The programs focus on primary care physicians but specialists such as cardiologists are expected to be critical collaborators. The prevalence of cardiovascular disease, its high costs and cardiologists’ involvement in population health endeavors already make them a logical partner.

Results from a pilot study assessing a demonstration ACO aren’t overly compelling. A before-after analysis of a program that compared ACO participation and nonparticipation found no decrease in discretionary and nondiscretionary coronary imaging and procedures and spending under the ACO. The authors and an editorial writer suggested cardiologists should be more integrated into the decision-making process.  

Another study published this week looked at the effects of market concentration on physician pricing. Cardiology was one of 10 specialties evaluated by researchers, who speculated that concentration could provide efficiencies that physicians could use to lower office visit prices or a less competitive market that they could exploit to raise prices.  

The researchers reported a great deal of concentration, and the less competitive markets had the highest prices. Given the continued trend toward consolidation, they warned that patients and payers may face higher costs for care.

Yet another study showed that costs per patient at hospital-owned and multihospital systems were higher than physician-run organizations. The study used health maintenance organization claims data in California, so the findings may not be applicable for other states. But like the physician pricing study, they nonetheless raise flags about consolidation.   

On the other hand, price transparency may turn the tide on rising costs. Patients who had access to a platform that allowed them to compare payments for medical services gravitated toward the less costly options. Overall, their choices led to a 13 percent reduction in claims payments compared with patients who did not use the pricing resource.  

Improving care in a cost-efficient manner is clearly multifaceted and dynamic. Studies like these give policy makers insights, if they heed the messages.

Candace Stuart

Editor, Cardiovascular Business