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Comparative Study
. 2016 Jun;211(6):998-1004.
doi: 10.1016/j.amjsurg.2015.07.021. Epub 2015 Oct 3.

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

Scott R Hawken  1 , Lindsey A Herrel  1 , Chandy Ellimoottil  1 , Zachary A Montgomery  1 , Zaojun Ye  1 , David C Miller  2
Affiliations
Comparative Study

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

Scott R Hawken et al. Am J Surg. 2016 Jun.

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.

Keywords: Accountable care organizations; Costs; Policy; Quality improvement; Surgery.

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Figures

Figure 1
Figure 1
The proportion of the most common inpatient surgical procedures performed in ACO-enrolling and non-enrolling hospitals (p<0.001).
Figure 2
Figure 2
The proportion of all major surgical procedures in ACO-enrolling and non-enrolling hospitals by surgical specialty service (p<0.001).
Figure 3
Figure 3
Adjusted costs (with 95% CI) of the 9 most common major inpatient surgical procedures in ACO-enrolling and non-enrolling hospitals (p>0.05).
See this image and copyright information in PMC

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