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

Abstract

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.

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

“…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.…”

The impact of Medicare shared savings program participation on hospital financial performance: An event‐study analysis

“…Our finding that MSSP participation had no negative effect on inpatient revenue in the full sample may seem contradictory to the current literature. Prior studies have found a reduction in inpatient utilization—specifically, significant drops in hospitalization and readmission rates among Medicare beneficiaries as a result of the MSSP 7,25,26 . Several ACO activities and strategies were directly targeted at reducing avoidable inpatient utilization, including expanding access to primary care and preventive care, developing care coordination across various providers, and monitoring specific patient groups with different medical needs 67–71 .…”

“…Prior research suggests that these strategies increase outpatient service utilization and reduce readmission, preventable hospitalization, and inpatient spending. 2 , 3 , 15 , 25 , 26 , 27 , 28 At the hospital level, these strategies may decrease inpatient revenue, but increase outpatient revenue from Medicare if the hospital has a robust outpatient business model. Second, the MSSP may result in growth in both inpatient and outpatient revenue because some MSSP ACOs are built on preferred provider networks that enable them to steer more patients to in‐network hospitals.…”

PA job availability in primary care during 2014 and 2016

“…34 A growing body of literature has been published on the impact of ACOs on care utilization and quality, and the results have been mixed. [35][36][37][38][39] A systematic review found that among published ACO outcomes, there is evidence that Medicare ACO implementation is associated with reduced hospital inpatient use and emergency department visits and improvements in some measures of preventive care and disease management. 35 The goals of ACOs are consistent with goals of other risk-bearing organizations, such as managed care organizations, for which historical data for quantifying differences in patient care utilization patterns are more readily available in databases like the Medical Expenditure Panel Survey (MEPS).…”