Key result
Hospital and skilled nursing facility participation in an ACO was associated with lower readmission rates (-1.7 percentage points, p=0.03) and reduced Medicare spending (-$940, p=0.001).
Why the study?
Does hospital and post-acute care provider participation in ACOs reduce readmission and Medicare spending in Medicare patients?
Observational
Yes
Does hospital and post-acute care provider participation in ACOs reduce readmission and Medicare spending in Medicare patients?
Effect estimate: Difference -1.7 percentage points
p-value: p=0.03
Hospital and skilled nursing facility participation in an Accountable Care Organization is associated with reduced readmission rates, lower Medicare spending, and shorter length of stay.
Does not support practice change from observational data; leaves open whether ACO participation causally reduces readmissions and spending.
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.
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Agarwal et al. (2018) conducted an observational in Medicare patients requiring hospital and post-acute care. Accountable Care Organization (ACO) participation vs. Non-participating hospitals and post-acute care providers was evaluated on Readmission rates (Difference -1.7 percentage points, p=0.03). Hospital and skilled nursing facility participation in an ACO was associated with lower readmission rates (-1.7 percentage points, p=0.03) and reduced Medicare spending (-$940, p=0.001).
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