{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:40:06Z","timestamp":1792392006506,"version":"4.4.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Because specialty care accounts for half of Medicare expenditures, improving its value is critical to the success of Medicare accountable care organizations (ACOs) in curbing spending growth. However, whether ACOs have reduced low-value specialty care without compromising use of high-value services remains unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>Using national Medicare data, we identified 2 cohorts: beneficiaries for whom the value of coronary revascularization is lower (those with ischemic heart disease without angina, congestive heart failure, or recent admission for acute myocardial infarction) and beneficiaries for whom its value is higher (those with recent acute myocardial infarction admission). We then determined the provider groups who cared for the cohorts, distinguishing between those participating (n=298) and those not participating in a Medicare ACO (1329). After measuring the provider groups\u2019 use of coronary artery bypass grafting and percutaneous coronary intervention among the 2 cohorts, we fit multivariable models to test the statistical significance of rates of change in low- and high-value revascularization after ACO participation. During the pre-ACO period, participating and nonparticipating provider groups had similar rates of low- and high-value revascularization. Our multivariable model results show that rates of change for low- and high-value coronary revascularization were not altered by a provider group\u2019s participation in a Medicare ACO (lower value: difference, \u22120.04 per year; 95% confidence interval, \u22120.11 to 0.03; higher value: difference, 0.96 per year; 95% confidence interval, \u22120.46 to 2.4).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>We found no association between provider group participation in a Medicare ACO and use of low- or high-value coronary revascularization.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.117.004492","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T10:10:23Z","timestamp":1528971023000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Medicare Accountable Care Organizations Are Not Associated With Reductions in the Use of Low-Value Coronary Revascularization"],"prefix":"10.1161","volume":"11","author":[{"given":"John M.","family":"Hollingsworth","sequence":"first","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology (J.M.H., P.Y., B.K.H.)"},{"name":"Institute for Healthcare Policy and Innovation (J.M.H., B.K.N., J.Z.A., B.K.H., A.M.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brahmajee K.","family":"Nallamothu","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation (J.M.H., B.K.N., J.Z.A., B.K.H., A.M.R.)"},{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine (B.K.N.)"},{"name":"University of Michigan Medical School, Ann Arbor, MI. Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI (B.K.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis","family":"Yan","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology (J.M.H., P.Y., B.K.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery (S.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI (S.L., A.M.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie H.","family":"Colla","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH (C.H.C., V.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Lewis","sequence":"additional","affiliation":[{"name":"The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH (C.H.C., V.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Z.","family":"Ayanian","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation (J.M.H., B.K.N., J.Z.A., B.K.H., A.M.R.)"},{"name":"Division of General Medicine, Department of Internal Medicine (J.Z.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent K.","family":"Hollenbeck","sequence":"additional","affiliation":[{"name":"Dow Division of Health Services Research, Department of Urology (J.M.H., P.Y., B.K.H.)"},{"name":"Institute for Healthcare Policy and Innovation (J.M.H., B.K.N., J.Z.A., B.K.H., A.M.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Institute for Healthcare Policy and Innovation (J.M.H., B.K.N., J.Z.A., B.K.H., A.M.R.)"},{"name":"Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI (S.L., A.M.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"Centers for Medicare & Medicaid Services. National Health Expenditure Projections 2016\u20132025. https:\/\/www.cms.gov\/Research-Statistics-Data-and-Systems\/Statistics-Trends-and-Reports\/NationalHealthExpendData\/Downloads\/proj2016.pdf. Accessed May 9 2017."},{"key":"e_1_3_3_3_2","unstructured":"Health Care Cost Institute. 2013 Health Care Cost and Utilization Report Appendix. 2014. http:\/\/www.healthcostinstitute.org\/files\/2013%20HCCUR%20Appendix%2010-28-14.pdf. Accessed February 7 2015."},{"key":"e_1_3_3_4_2","unstructured":"The Organisation for Economic Co-operation and Development. Why Is Health Spending in the United States So High? 2011. http:\/\/www.oecd.org\/unitedstates\/49084355.pdf. 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Final rule.","volume":"81","author":"Centers for Medicare & Medicaid Services, HHS","year":"2016","unstructured":"Centers for Medicare & Medicaid Services, HHS. Medicare program; Medicare shared savings program; accountable care organizations\u2013revised benchmark rebasing methodology, facilitating transition to performance-based risk, and administrative finality of financial calculations. Final rule. 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