PROJECT SUMMARY
To address perverse incentives in the fee-for-service (FFS) payment system, the 2010 Affordable Care Act
(ACA) established a wide range of alternative payment models in which providers are reimbursed or penalized
based on cost-efficiency, process quality, and health outcomes. One of the largest alternative payment models
that was created by the ACA is the Accountable Care Organization (ACO), launched through the Medicare
Shared Savings Program (MSSP) in 2012. A Medicare ACO is a group of doctors and other healthcare
providers who agree to work together to improve the quality and cost of care by providing better-coordinated
care to Medicare FFS patients across the care continuum. An MSSP ACO’s final reimbursement from
Medicare is determined by both the ACO’s cost efficiency relative to its pre-determined benchmark
expenditures and the ACO’s performance on more than 23 quality measures. As of January 1, 2022, there
were 483 MSSP ACOs covering almost 30% of the entire FFS Medicare population. Existing evaluations of the
MSSP program provide evidence that the program may be effective at improving processes of care and clinical
outcomes and reducing utilization and spending. However, no research studies have evaluated the impact of
MSSP ACOs on reducing the risk of falls and fall-related injuries among older adults. Annually, approximately
30% to 40% of community-dwelling adults aged 65 years and older experience a fall, which leads to an
estimated $51 billion in spending. The MSSP ACOs have one specific preventative care quality indicator that
aims to address the issue of falls among older adults: Percentage of patients 65 years of age and older who
were screened for future fall risk during the measurement period (“ACO13”). The proposed study aims to
evaluate the effect of the MSSP ACOs on the rate of screening for future fall risk and fall-related healthcare
utilization among older (65+) FFS Medicare beneficiaries. To assess the impact of the MSSP ACOs on fall risk
screening and fall-related healthcare utilization, we will conduct matched difference-in-differences analyses
with year and state fixed effects using linked Medicare claims, CMS MSSP ACO Files, and SNF, IRF and HHA
assessment data across 2010-2016. Specifically, we will pursue the following aims: (1) Compare the rate of
screening for fall risk among older Medicare FFS beneficiaries who are attributed to MSSP ACOs as compared
to those who are not attributed to MSSP ACOs; and (2) Compare rates of fall-related ED/outpatient visits,
hospital admissions, and post-acute care utilization among older Medicare FFS beneficiaries who are
attributed to MSSP ACOs as compared to those who are not attributed to MSSP ACOs. The expected outcome
of this research is the first-ever national evidence of whether ACOs have improved care management and
healthcare utilization among older adults who are at risk of falls. This study will provide comprehensive
information to guide policy decisions as Medicare continues to modify ACO initiatives to incentivize value.
