Do Changes in Post-acute Care Use at Hospitals Participating in an Accountable Care Organization Spillover to All Medicare Beneficiaries?

Abstract

Hospital participation in an ACO did not result in spillovers in PAC utilization or payments to all beneficiaries, even when considering high PAC-use conditions and ACO hospitals that also have an ACO-participating PAC.

Association of Patient Outcomes With Bundled Payments Among Hospitalized Patients Attributed to Accountable Care Organizations

“…All models used time and hospital fixed effects, and models for the ACO cohort followed prior work and included ACO fixed effects. 21 By allowing each ACO and hospital to serve as a control for itself, ACO and hospital fixed effects enabled examination associations within ACOs (ie, for bundled payment vs non-bundled payment patients attributed to the same ACO) and within hospitals (ie, for non-ACO vs ACO patients admitted to the same bundled payment hospital). We adopted this approach to mitigate bias from unobserved differences between ACOs and hospitals.…”

“…Accountable care organizations have been particularly effective in reducing avoidable hospitalizations, whereas bundles have been effective in reducing expensive care during and after hospitalization. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 As such, there is the possibility that the 2 models complement each other in ways that could produce additive benefits. For instance, bundled payments may target transitions between hospitals and postacute care facilities, whereas ACOs target transitions from postacute facilities back into ongoing outpatient care.…”

“… 9 The 2 models could have additive benefits, as bundles have focused on utilization in hospital and postacute settings, and ACOs may contribute additional benefits in those settings through their focus on utilization across the care continuum. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Conversely, the payment models may produce some or no additive benefits if simultaneous care under both involves duplicative or uncoordinated care.…”

“…Patient inclusion in both has increased over time, with approximately 30% of all patients who receive care under bundled payments also being attributed to an ACO . The 2 models could have additive benefits, as bundles have focused on utilization in hospital and postacute settings, and ACOs may contribute additional benefits in those settings through their focus on utilization across the care continuum . Conversely, the payment models may produce some or no additive benefits if simultaneous care under both involves duplicative or uncoordinated care.…”

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

“…Additionally, prior work has shown only very small changes in utilization of SNF and HH after ACO implementation for Pioneer ACOs (Nyweide et al. ) and for MSSP ACOs (Navathe, Bain, and Werner ). Moreover, ACO‐driven reductions in PAC use are expected to be among the healthiest patients, leaving the sickest patients in PAC.…”