Effect of Hospital and Post-Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Health Expenditures* ; Outcome Assessment, Health Care*; Accountable Care Organizations/*economics ; Medicare/*economics ; Subacute Care/*economics; Accountable Care Organizations/statistics & numerical data ; Aged, 80 and over ; Fee-for-Service Plans ; Female ; Hospitals ; Humans ; Length of Stay/statistics & numerical data ; Male ; Medicare/statistics & numerical data ; Patient Discharge ; Patient Readmission/statistics & numerical data ; Skilled Nursing Facilities/statistics & numerical data ; Subacute Care/statistics & numerical data ; United States

Objective: To test for differences in patient outcomes when hospital and post-acute care (PAC) providers participate in accountable care organizations (ACOs).
Data/setting: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO-participating hospitals and PAC providers.
Design: We compared changes in outcomes among patients discharged from ACO-participating hospitals/PACs before and after participation to changes among patients discharged from non-participating hospitals/PACs over the same time period.
Results: Patients discharged from an ACO-participating hospitals and skilled nursing facilities (SNF) had lower readmission rates (-1.7 percentage points, p-value = .03) than before ACO participation and non-participants; and lower per-discharge Medicare spending (-$940, p-value = .001), and length of stay (-3.1 days, p-value <.001) in SNF. Effects among ACO-participating hospitals without a co-participating SNF were smaller. Patients discharged from an ACO-participating hospital and home health agency had lower Medicare per-discharge spending (-$209; p-value = .06) and length of stay (-1.6 days, p-value <.001) for home health compared to before ACO participation and non-participants. Discharge from an ACO-participating hospital and inpatient rehabilitation facility did not impact patient outcomes or spending.
Conclusions: Hospital and SNF participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay. These results lend support to the ACO payment model.
(© Health Research and Educational Trust.)

J Gen Intern Med. 2003 Aug;18(8):646-51. (PMID: 12911647)
Health Serv Res. 2016 Aug;51(4):1595-611. (PMID: 26799992)
Health Aff (Millwood). 2010 May;29(5):982-90. (PMID: 20439895)
Arch Intern Med. 2005 Sep 12;165(16):1842-7. (PMID: 16157827)
Am Econ Rev. 1996 Mar;86(1):1-24. (PMID: 10168326)
N Engl J Med. 2011 Apr 21;364(16):e32. (PMID: 21452999)
Health Aff (Millwood). 2013 May;32(5):864-72. (PMID: 23650319)
JAMA. 2015 Jun 2;313(21):2152-61. (PMID: 25938875)
J Gen Intern Med. 2018 Jun;33(6):831-838. (PMID: 29520748)
N Engl J Med. 2015 May 14;372(20):1927-36. (PMID: 25875195)
JAMA Intern Med. 2017 Apr 1;177(4):518-526. (PMID: 28192556)
N Engl J Med. 2016 Jun 16;374(24):2357-66. (PMID: 27075832)
Hosp Formul. 1992 Jul;27(7):720-4. (PMID: 10119187)
J Gen Intern Med. 2002 Mar;17(3):186-92. (PMID: 11929504)

K24 AG047908 United States AG NIA NIH HHS; R01 HS024266 United States HS AHRQ HHS

Keywords: Medicare; Post-acute care; accountable care organizations; hospitals

Date Created: 20180802 Date Completed: 20190314 Latest Revision: 20240403

20240403

PMC6232507

10.1111/1475-6773.13023

30066420