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Member Research and Reports

Member Research and Reports

Michigan: Medicare Program Aimed at Lowering Costs, Improving Care May Not Work as Well as Thought

As the Medicare system seeks to improve the care of older adults while also keeping costs from growing too fast, a new study led by a University of Michigan team suggests that one major effort may not be having as much of an impact as hoped. 

A new analysis of data from the Medicare Shared Savings Program (MSSP) finds that high-cost physicians and high-cost patients dropping out of the program accounted for much of the savings reported from 2008 to 2014. 

After the effects of those departures were taken into account, the Accountable Care Organizations (ACOs) taking part in the MSSP had the same costs as physicians in their area who weren’t taking part in ACOs but also took care of other patients with traditional Medicare coverage.

The findings suggest that as the federal government continues its effort to “bend the cost curve” for Medicare through voluntary reforms, it should take into consideration year-to-year shifts in which providers and patients are taking part in ACOs. Otherwise, the researchers say, “selection bias” could skew the interpretation of the program’s effects. 

“Our results suggest that there is less reason for optimism about the MSSP’s effects to date than might have been suggested by other studies,” says Dr. Andy Ryan, senior author and a professor at the University of Michigan School of Public Health. “We hope CMS will consider the implications as it moves forward with evaluating programs aimed at improving the long-term sustainability of the Medicare system.”

Dr. Ryan worked with Mr. Adam Markovitz, who led the analysis as part of his doctoral degree in public health and is now completing his medical degree at the University of Michigan Medical School as part of the Medical Scientist Training Program. 

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