Though both ACO and non-ACO hospitals have been successful in driving down rates of readmissions from skilled nursing facilities, hospitals participating in Medicare ACOs have done so measurably faster, according to a study published in the January issue of Health Affairs.
Conducted by researchers from Providence, R.I.-based Brown University, the study is based on discharge and readmission data from 2007 to 2013 for 220 ACO-affiliated hospitals and 1,840 non-ACO hospitals. Over this time period, the ACA was implemented, Medicare began penalizing hospitals for excess readmissions and two ACO programs launched: the Medicare Shared Savings Program and the Pioneer model.
The researchers found all hospitals reduced readmission rates over the time period. Non-ACO hospitals reduced readmissions by 13.1 percent from 2007 to 2013. Comparatively, hospitals in Pioneer ACOs reduced readmissions by 14.9 percent and hospitals in MSSP ACOs reduced them by 17.7 percent. The study also differentiated "quick" readmissions within the first three days of discharge from long-term readmissions within four to 30 days after discharge. The researchers hoped to see if readmissions were caused by the hospital (quick) or the skilled nursing facility (long-term). However, they found both quick and long-term readmissions declined overall and especially in ACOs.
"This is about understanding whether ACOs work or not," Momotazur Rahman, PhD, a study co-author and assistant professor at the Brown University School of Public Health, said in a statement. "It seems like they are doing slightly but significantly better than non-ACO hospitals."
The data suggests ACO-affiliated hospitals are doing something — communicating better with SNFs, targeting at-risk patients better or discharging more effectively — to improve readmission rates at a faster rate than non-ACO hospitals. However, the researchers were unable to pinpoint why this pattern occurred. "Further studies are warranted to examine the exact mechanisms that brought about this improvement and what roles ACOs play in continued decreasing rates of rehospitalizations to hospitals," the study concludes.
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