Scott R Hawken1, Lindsey A Herrel1, Chandy Ellimoottil1, Zachary A Montgomery1, Zaojun Ye1, David C Miller2. 1. Department of Urology, University of Michigan, NCRC Building 16, Room 108E, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, USA. 2. Department of Urology, University of Michigan, NCRC Building 16, Room 108E, 2800 Plymouth Road, Ann Arbor, MI, 48109-2800, USA. Electronic address: dcmiller@med.umich.edu.
Abstract
BACKGROUND: To anticipate the effects of accountable care organizations (ACOs) on surgical care, we examined pre-enrollment utilization, outcomes, and costs of inpatient surgery among hospitals currently enrolled in Medicare ACOs vs nonenrolling facilities. METHODS: Using the Nationwide Inpatient Sample (2007 to 2011), we compared patient and hospital characteristics, distributions of surgical specialty care, and the most common inpatient surgeries performed between ACO-enrolling and nonenrolling hospitals before implementation of Medicare ACOs. We used multivariable regression to compare pre-enrollment inpatient mortality, length of stay (LOS), and costs. RESULTS: Hospitals now participating in Medicare ACO programs were more frequently nonprofit (P < .001) and teaching institutions (P = .01) that performed more specialty procedures (P < .001). We observed no clinically meaningful pre-enrollment differences for inpatient mortality, prolonged length of stay, or costs for procedures performed at ACO-enrolling vs nonenrolling hospitals. CONCLUSIONS: Medicare ACO hospitals had pre-enrollment outcomes that were similar to nonparticipating facilities. Future studies will determine whether ACO participation yields differential changes in surgical quality or costs.
BACKGROUND: To anticipate the effects of accountable care organizations (ACOs) on surgical care, we examined pre-enrollment utilization, outcomes, and costs of inpatient surgery among hospitals currently enrolled in Medicare ACOs vs nonenrolling facilities. METHODS: Using the Nationwide Inpatient Sample (2007 to 2011), we compared patient and hospital characteristics, distributions of surgical specialty care, and the most common inpatient surgeries performed between ACO-enrolling and nonenrolling hospitals before implementation of Medicare ACOs. We used multivariable regression to compare pre-enrollment inpatient mortality, length of stay (LOS), and costs. RESULTS: Hospitals now participating in Medicare ACO programs were more frequently nonprofit (P < .001) and teaching institutions (P = .01) that performed more specialty procedures (P < .001). We observed no clinically meaningful pre-enrollment differences for inpatient mortality, prolonged length of stay, or costs for procedures performed at ACO-enrolling vs nonenrolling hospitals. CONCLUSIONS: Medicare ACO hospitals had pre-enrollment outcomes that were similar to nonparticipating facilities. Future studies will determine whether ACO participation yields differential changes in surgical quality or costs.
Authors: James M Dupree; Kavita Patel; Sara J Singer; Mallory West; Rui Wang; Michael J Zinner; Joel S Weissman Journal: Health Aff (Millwood) Date: 2014-06 Impact factor: 6.301
Authors: J Hunter Mehaffey; Robert B Hawkins; Matthew G Mullen; Max O Meneveau; Bruce Schirmer; Irving L Kron; R Scott Jones; Peter T Hallowell Journal: J Am Coll Surg Date: 2016-12-23 Impact factor: 6.113