Understanding pre-enrollment surgical outcomes for hospitals participating in Medicare Accountable Care Organizations

• Published in: The American journal of surgery 2016-06, Vol.211 (6), p.998-1004
• Main Authors: Hawken, Scott R., M.S, Herrel, Lindsey A., M.D, Ellimoottil, Chandy, M.D. M.S, Montgomery, Zachary A, Ye, Zaojun, M.S, Miller, David C., M.D. M.P.H
• Format: Article
• Language: English
• Subjects: Accountable care organizations; Accountable Care Organizations - economics; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Cholecystectomy; Classification; Codes; Comprehension; Coronary vessels; Cost control; Costs; Databases, Factual; Family income; Female; Health Care Costs; Health Care Reform; Heart surgery; Hospitals; Hospitals - statistics & numerical data; Humans; Male; Medicaid; Medicare; Medicare - economics; Medicare - utilization; Middle Aged; Mortality; Outcome Assessment (Health Care); Policy; Policy Making; Quality improvement; Retrospective Studies; Statistics, Nonparametric; Surgery; Surgical outcomes; Surgical Procedures, Operative - economics; Surgical Procedures, Operative - methods; United States
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2015.07.021

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.