Recent Evidence on the Inclusion of Hospice and Palliative Care Physicians in Medicare Shared Savings Program Accountable Care Organization Networks.

OBJECTIVE: To document the presence of hospice and palliative physicians in Medicare Shared Savings Program (MSSP) ACOs.

BACKGROUND: End-of-life care exhibits extreme variation in quality, cost, and patient experience. This baseline creates opportunities for improvements that would be financially rewarded in the new value-based reimbursement environment, such as the accountable care organization (ACO) model. Little is known about how ACOs have responded to this opportunity by including hospice and palliative providers in their formal provider networks.

DESIGN: This is a cross-sectional analysis of 2014 MSSP ACO provider networks assessing inclusion of a hospice or palliative physician.

SETTING/SUBJECTS: This study included MSSP ACO provider networks.

RESULTS: Approximately three-quarters of MSSP ACOs did not formally contract with a hospice or palliative care physician in 2014. Inclusion of a hospice or palliative physician was associated with other specialists that commonly refer to hospice and palliative care, such as oncologists.

DISCUSSION: By rewarding innovation that lowers expenditures, the ACO model encourages attention to care that exhibits high variation and expense. Both hospice and palliative care have been shown to reduce costs and improve the patient experience, making them potentially powerful tools in an ACO's arsenal. However, the MSSP ACO model has not emphasized care of seriously and terminally ill individuals, and thus it is not surprising that there has been consistently low inclusion of hospice and palliative care physicians in MSSP provider networks.