(HealthDay News) — From 2012 to 2016, there was an increase in the percentage of Medicare beneficiaries on long-term dialysis who were aligned to an accountable care organization (ACO), with a reduction in spending seen for ACO-aligned beneficiaries, according to a study published online in the Clinical Journal of the American Society of Nephrology.

Shivani Bakre, from the University of Michigan in Ann Arbor, and colleagues conducted a retrospective cohort study involving 135,152 Medicare beneficiaries on long-term dialysis between 2009 and 2016. Trends in alignment to an ACO were compared to those of the general Medicare population. The researchers examined the association between ACO alignment and the primary outcome of total spending for beneficiaries on long-term dialysis from prior to ACO implementation (2009 to 2011) through implementation of the Comprehensive End-Stage Renal Disease Care model in 2015.

The researchers found that from 2012 to 2016, the percentage of beneficiaries on long-term dialysis aligned to an ACO increased from 6 to 23%. The time-series analysis showed that spending was $143 less (95% confidence interval, $5 to $282 less) per beneficiary-quarter for ACO-aligned beneficiaries compared with nonaligned beneficiaries. Savings by ACO-aligned beneficiaries were limited to those receiving care from a primary care physician ($235; 95% confidence interval, $73 to $397) in analyses stratified by type of care provider.

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“Additional research focused on a better understanding of how the more typically primary care centric ACOs achieved savings for long-term dialysis beneficiaries may provide useful insights to inform future models of care delivery,” the authors write.


Bakre S, Hollingsworth JM, Yan PL, Lawton EJ, Hirth RA, Shahinian VB. Accountable care organizations and spending for patients undergoing long-term dialysis. Clin J Am Soc Nephrol.

Awan AA, Erickson KF. ACOs and bending the cost curve for health care spending for people with kidney failure.