Inclusion of Nursing Homes and Long-term Residents in Medicare ACOs

Abstract

Background: Long-term nursing home residents have complex needs that often require services from acute care settings. The accountable care organization (ACO) model provides an opportunity to improve care by creating payment incentives for more coordinated, higher quality care. Objectives: To assess the extent of nursing home participation in ACOs, and the characteristics of residents and their nursing homes connected to ACOs. Research Design: This was a cross-sectional study. Subjects: Medicare nursing home residents identified from 2014 Minimum Data Set assessments. Residents were attributed to ACOs based on Medicare methods. Measures: Individuals’ demographics, clinical characteristics, health care utilization, and nursing home characteristics. Results: Among 660,780 nursing home residents, a quarter of them were attributed to ACOs. ACO residents had only small differences from non-ACO residents: age 85 years and older (47.1% vs. 45.3%), % black (10.5% vs. 12.7%), % dual eligible (74.3% vs. 75.8%), and emergency department visits (55.1 vs. 57.3 per 100). Of the 14,868 nursing homes with study residents, few were ACO providers (N=222, 1.6% of total residents) yet many had at least one ACO resident (N=8077, 76.4% of total residents); one-fifth had at least 20 (N=2839, 33.4% of total residents). ACO-provider homes were more likely than other homes to have a 5-star rating, be hospital-based and have Medicare as the primary payer. Conclusions: With a quarter of long-term nursing home residents attributed to an ACO, and one-fifth of nursing homes caring for a large number of ACO residents, outcomes and spending in this setting are important for ACOs to consider when designing patient care strategies.

Risk Selection and Care Fragmentation at Medicare Accountable Care Organizations for Patients With Dementia

“…Although the mechanisms are unclear, our results provide evidence of risk selection on dementia status resulting in substantially lower enrollment of such patients in ACOs, including dementia patients dwelling in the community. Prior studies focused solely on nursing home patients with dementia and also found lower ACO enrollment 23–26 . These results confirm prior predictions that ACOs would be incented to engage in risk selection to avoid patients with dementia due to a lack of risk adjustment for this condition by Medicare 22 .…”

“…Prior studies focused solely on nursing home patients with dementia and also found lower ACO enrollment. [23][24][25][26] These results confirm prior predictions that ACOs would be incented to engage in risk selection to avoid patients with dementia due to a lack of risk adjustment for this condition by Medicare. 22 Such patterns had been seen previously in the MA program, 41 where dementia was also not included in the risk models that determined per-member payment rates.…”

“…22 Although ACOs hold promise for patients with dementia, little is known about ACO enrollment and care patterns for this population. To date, studies of patients with dementia in Medicare ACOs have focused on nursing home residents, [23][24][25][26] which comprise only one quarter of dementia patients, mostly in later stages of the disease. Due to forecasted continued growth of ACOs in Medicare, it is crucial to understand how many dementia patients are being enrolled by ACOs, whether there is evidence of risk selection against such patients by ACOs, and what impact ACO enrollment has on ambulatory care treatment and care fragmentation for patients with dementia.…”

The Association Between Facility Affiliations and Revenue Generation in Skilled Nursing Facilities – An Exploratory Study

“…When collaborating entities in an ACO succeed in delivering high-quality care at a lower cost, the group shares in the savings it realizes. 31 …”

COVID‐19: The Time for Collaboration Between Long‐Term Services and Supports, Health Care Systems, and Public Health Is Now

“…A complex mix of for‐profit, private, and public ownership usually means that LTSS facilities and nearby hospitals are not part of the same vertically integrated system. Memoranda of understanding (MOUs) or formal contracts reflecting the now popular models of “patient‐centered medical homes” or “accountable care organizations” may be a philosophical as well as a practical answer to such gaps in coordination 75 …”