Early Effects of an Accountable Care Organization Model for Underserved Areas

Trombley, Matthew J.; Fout, Betty; Brodsky, Sasha; McWilliams, J. Michael; Nyweide, David J.; Morefield, Brant

doi:10.1056/nejmsa1816660

Cited by 39 publications

(39 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Likewise, relying on hospitals as the unit of analysis precludes us from differentiating between ACO and non‐ACO patients. Our finding that rural hospitals do not experience significant changes in utilization as a result of ACO participation does not contradict recent research that ACOs operating in rural and underserved areas have been successful in reducing costs and inpatient utilization 13 . Rather, these results can be taken together to indicate that the successes of rural ACOs have not led to reductions (or increases) in utilization among their rural hospitals.…”

Section: Discussionsupporting

confidence: 49%

“…Although weak, the evidence of an increase in Critical Access Hospital's inpatient discharges associated with ACO participation merits consideration. These results do not necessarily contradict the substantial body of literature indicating that ACOs reduce inpatient utilization 13,18 . Rather, by focusing on the perspective of rural hospitals, we may be seeing suggestive evidence of ACOs redirecting patients to their local Critical Access Hospitals for inpatient care they may have previously sought elsewhere.…”

Section: Discussionsupporting

confidence: 46%

“…Rural ACOs demonstrated early successes: in 2014, 46% achieved savings and 15% earned shared savings bonuses 12 . The ACO Investment Model, specifically designed to encourage rural providers to participate in ACOs, saved Medicare $48.6 million in 2016, primarily by reducing hospitalizations and post‐acute care spending 13 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Assessing the Short‐Term Association Between Rural Hospitals’ Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance

Comfort

Fulton

Shortell

2020

The Journal of Rural Health

View full text Add to dashboard Cite

Purpose Although much research has been done on accountable care organizations (ACOs), little is known about their impact on rural hospitals. We examine the association between rural hospitals’ participation in an ACO and their performance on utilization and financial measures. Methods This quasi‐experimental study estimates the relationship between voluntary ACO participation and hospital metrics using propensity score‐matched, longitudinal regression models with year and hospital fixed effects. Regression models controlled for secular trends and time‐varying hospital and county characteristics. Hospital measures were from the American Hospital Association, RAND Hospital Data, and Leavitt Partners. The initial population comprises 643 rural hospitals that participated in an ACO for at least one year during the 2011 to 2018 study period and 1,541 rural hospitals that did not participate in an ACO. From this population we created a sample of propensity score‐matched hospitals consisting of 525 ACO‐participating and 525 comparable non‐ACO hospitals. Results Rural hospitals’ participation in an ACO is not associated with changes in hospital utilization or financial measures, nor is there an association between these performance metrics and whether another within‐county hospital participated in an ACO. A secondary analysis limited to Critical Access Hospitals provides some evidence that inpatient utilization increases in the second year of ACO participation, though the increases are not significant in year 3 and beyond. Conclusion We find no evidence that rural hospitals experience substantive changes in outpatient visits, inpatient utilization, or operating margin in the years immediately after joining an ACO.

show abstract

Section: Discussionsupporting

confidence: 49%

Section: Discussionsupporting

confidence: 46%

See 1 more Smart Citation

Assessing the Short‐Term Association Between Rural Hospitals’ Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance

Comfort

Fulton

Shortell

2020

The Journal of Rural Health

View full text Add to dashboard Cite

show abstract

“…Auto‐Regressive Integrated Moving Average (ARIMA) model was widely used in epidemiological study to predict future outcomes (Longtin et al 2016; Song et al 2018; Trombley et al 2019). ARIMA model was performed in Python (version: 3.7.4) software to forecast vision loss burden from 2018 towards 2050.…”

Section: Methodsmentioning

confidence: 99%

Global burden and gender disparity of vision loss associated with diabetes retinopathy

Wang²,

Lin

et al. 2020

Acta Ophthalmologica

View full text Add to dashboard Cite

Purpose To assess the trend patterns and gender disparity in global burden of vision loss due to diabetic retinopathy (DR) by year, age, region and socioeconomic status using prevalence and years lived with disability (YLDs) from Global Burden of Disease (GBD) study 2017. Methods Prevalence and YLDs data of vision loss attributable to DR were extracted from GBD Study 2017 in 195 countries and territories. Socio‐demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. Kruskal–Wallis test, Dunn’s multiple comparisons and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic levels. Results Globally, total age‐standardized prevalence and YLDs rates of vision loss due to DR peaked around 2005, with prevalence rate of 58.98 [95% uncertainty interval (UI) 50.95–68.56] and YLDs rate of 5.00 (95% UI 3.51–6.84) per 100 000 population, respectively. The burden were expected to increase to 65.74 (95% UI 60.14–70.86) and 5.68 (95% UI 4.07–7.22) by 2050. The burden would increase according to our projection based on current epidemiological situation. However, gender disparity has existed since 1990 and been enlarging in recent years, with female being more heavily impacted. This pattern remained with ageing among different stages of vision impairments and varied through GBD super regions. Gender difference (females minus males) of age‐standardized prevalence rates was positively related to SDI (r = 0.1661, p = 0.0203). Diabetes has become a more important risk over the past 3 decades among the leading causes of vision loss. Conclusions The DR‐related vision loss burden tended to increase under ageing population according to our projection with significant gender disparity. Public awareness of DR and gender sensitive health policy should be emphasized.

show abstract

“…Existing evidence indicates that participation in the MSSP produced modest reductions in Medicare spending for ACO patients, [2][3][4][5][6] even after accounting for bonus payments. However, churn in the patients attributed to ACOs and in the providers included in ACO contracts has raised concerns that some of the savings might be an artifact of risk selection-i.e., the result of ACOs encouraging high-cost patients to switch to a non-ACO provider or excluding clinicians with high-cost patients from ACO contracts.…”

Section: Introductionmentioning

confidence: 99%

Spending Reductions in the Medicare Shared Savings Program: Selection or Savings?

McWilliams¹,

Hatfield²,

Landon³

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

Early Effects of an Accountable Care Organization Model for Underserved Areas

Cited by 39 publications

References 6 publications

Assessing the Short‐Term Association Between Rural Hospitals’ Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance

Assessing the Short‐Term Association Between Rural Hospitals’ Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance

Global burden and gender disparity of vision loss associated with diabetes retinopathy

Spending Reductions in the Medicare Shared Savings Program: Selection or Savings?

Contact Info

Product

Resources

About