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

作者：Hawken Scott R; Herrel Lindsey A; Ellimoottil Chandy; Montgomery Zachary A; Ye Zaojun; Miller David C^*

来源：American Journal of Surgery, 2016, 211(6): 998-1004.

DOI：10.1016/j.amjsurg.2015.07.021

• Surgery
• Quality improvement
• Costs
• Accountable care organizations
• Policy

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.

• 出版日期2016-6