Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data

Colla, Carrie H.; Lewis, Valerie A.; Tierney, Emily; Muhlestein, David

doi:10.1377/hlthaff.2015.0919

Cited by 82 publications

(99 citation statements)

References 21 publications

(24 reference statements)

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“…Moreover, compared with hospital-integrated ACOs, ACOs that are independent physician groups report similar capacity for influencing inpatient care—and thus decisions about post-acute care at discharge—presumably by staffing admissions directly or using hospitalist groups or care managers to influence their patients’ inpatient care. 10 Our results are consistent with ACOs using similar strategies to shorten length of SNF stays, such as employing or partnering with clinicians to follow patients in SNFs.…”

Section: Discussionsupporting

confidence: 85%

Changes in Postacute Care in the Medicare Shared Savings Program

et al. 2017

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IMPORTANCEPostacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. OBJECTIVE To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. DESIGN, SETTING, AND PARTICIPANTS With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. EXPOSURES Patient attribution to an ACO in the MSSP. MAIN OUTCOMES AND MEASURES Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. RESULTS For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control

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Section: Discussionsupporting

confidence: 85%

Changes in Postacute Care in the Medicare Shared Savings Program

et al. 2017

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“…11 Recent studies have shown that commercial and noncommercial ACOs are increasing in number; half are led by physician groups; and included hospitals are more likely to be nonprofit, mid-size and large hospitals in the Northeast and Midwest. 10,12–14 …”

mentioning

confidence: 99%

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

et al. 2017

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Medicare’s more than 420 accountable care organizations (ACOs) provide care for a considerable percentage of the elderly in the United States. One goal of ACOs is to improve care coordination and thereby decrease rates of rehospitalization. We examined whether ACO-affiliated hospitals were more effective than other hospitals in reducing rehospitalizations from skilled nursing facilities. We found a general reduction in rehospitalizations from 2007 to 2013, which suggests that all hospitals made efforts to reduce rehospitalizations. The ACO-affiliated hospitals, however, were able to reduce rehospitalizations more quickly than other hospitals. The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities. Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly. However, further work is needed to investigate the precise mechanisms that underlie the reduction of readmissions among ACO-affiliated hospitals.

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“…[3,22] Organizations owning hospitals and specialty practices have weaker incentives than those that do not to limit use of inpatient and specialty care under ACO contracts, and evidence from Medicare and commercial ACO initiatives suggests that providers can successfully influence use of care in multiple settings without formal ownership arrangements uniting providers. [3,23,24]…”

Section: Empirical Evidence and The Prevailing Concernmentioning

confidence: 99%

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models

Neprash

Chernew

McWilliams³

2017

Health Affairs

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Provider consolidation has been associated with higher health care prices and spending. Prevailing wisdom assumes that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing from a number of data sources from 2008 onward, we examined the relationship between Medicare’s Accountable Care Organization (ACO) programs and provider consolidation. According to multiple measures, consolidation was underway in 2008–2010, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and specialty-oriented physician group size increased after the ACA, we found minimal evidence associating consolidation with ACO penetration at a market level or with ACO participation by physicians within markets. We conclude that payment reform has been associated with little acceleration in consolidation apart from trends already underway, but with some evidence of potential defensive consolidation in response to new payment models.

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Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data

Cited by 82 publications

References 21 publications

Changes in Postacute Care in the Medicare Shared Savings Program

Changes in Postacute Care in the Medicare Shared Savings Program

ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models

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