difference between retrospective and prospective

3,11 Polypharmacy increases with comorbidity, increasing risk of adverse reactions and inappropriate use. 6-10 As a result, serious illness care is often fragmented or incomplete. 3-5 Most patients with serious illness have multiple comorbidities and functional limitations, which require medical and social services from providers and caregivers. Improving serious illness care is critical to curb the trend of increasing health care expenditures, as the top 5% of spenders account for nearly 60% of health care costs. In prospective attribution, patients are assigned at the start of the contract PY based on claims in the prior calendar year, which allows ACOs to know their defined population and provide care management during the PY. In retrospective attribution, patients who received care from the ACO during the PY are captured in the ACO population. In retrospective attribution, patients are assigned based on care provided during the contract year, and final attribution occurs at the end of the contract performance year (PY).

1 Retrospective and prospective options both use claims-based algorithms to attribute patients to an ACO if a plurality of qualifying services over a 12-month period are received from a participating provider. 2 Beginning in 2019, the Pathways to Success MSSP rule allows ACOs an annual attribution choice: retrospective or prospective (potentially supplemented by voluntary patient attribution).

Since program inception, CMS required MSSP ACOs to use retrospective assignment, with the exception of the 8% of ACOs in Track 3 or the Next Generation Track, which both started in 2016. Little is known about how ACOs’ choice of attribution method affects ACO attribution, and thus incentives for care, for seriously ill Medicare beneficiaries.Īttribution methods in MSSP have evolved over time. 1 Seriously ill patients with high needs, costs, and functional limitations have a high risk of death and may benefit from ACO care management strategies. Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) in the Basic or Enhanced tracks to choose either retrospectively or prospectively attributed ACO patient populations.

The difference was $834 (95% CI, $402-$1266) greater per capita among ACOs that achieved shared savings.Ĭonclusions: The difference in survival and spending for ACO populations captured by prospective vs retrospective attribution methods means that ACOs may need to employ different care management strategies to improve performance depending on their attribution method. Among ACOs that did not achieve shared savings, average per capita Medicare expenditures (after truncation) were $2459 (95% CI, $2192-$2725) higher for prospective vs retrospective ACO populations. Similarly, hospice use was associated with reduced odds of retrospective assignment (OR, 0.80 95% CI, 0.79-0.80). Results: Dying in the first 90 days of the performance year was associated with reduced odds of retrospective ACO attribution (odds ratio, 0.24 95% CI, 0.24-0.25) relative to beneficiaries surviving 270 days or longer. Methods: We used generalized linear models with ACO and year fixed effects to estimate the average within-ACO difference between potential retrospective and prospective ACO populations. Study Design: This retrospective, cross-sectional analysis describes survival, patient characteristics, and Medicare spending for Medicare fee-for-service beneficiaries identified with serious illness (n = 1,600,629) using 100% Medicare Master Beneficiary Summary and MSSP beneficiary files (2014-2016). To understand how ACOs’ choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and retrospective ACO populations. Objectives: Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations.

Difference between retrospective and prospective