ACOs have minimal effect on provider consolidation: 3 study findings

While the number of hospital mergers and size of specialty-owned physician groups increased following the ACA's enactment, there is little evidence consolidation was linked with the proliferation of ACOs — a trend that was on the rise before the ACA became law, according to a Harvard University study published in Health Affairs

Researchers examined data regarding the relationship between Medicare's ACO programs and provider consolidation from 2008 onward. They used Medicare claims data from 2008 to 2013, data from the American Hospital Association Annual Survey during the same period and data from 2008 to 2015 from Irving Levin Associates' Health Care Mergers and Acquisitions Database.

The study compared consolidation over time between markets with more versus less ACO contracting in 2014, and within markets between physicians entering an ACO contract by 2014 compared to those who had not.

Here are three findings from the study.

1. According to the report, provider consolidation had occurred between 2008 and 2010, prior to the ACA's creation of Medicare ACO programs. 

2. While provider market concentration and prices increased significantly between 2008 and 2013, there was minimal change between the pre-ACA period (2008 to 2010) and the post-ACA period (2011 to 2013). 

3. Researchers concluded "payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models." 

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