Hospitals affiliated with Medicare accountable care organizations were able to reduce readmission rates of patients at skilled nursing facilities at a faster clip than other hospitals, a new study has found.
The research, which was published in Health Affairs, found that ACO-affiliated hospitals discharged patients to skilled nursing facilities more often, but readmission rates dropped faster.
Between 2007 and 2013, Pioneer ACO-affiliated hospitals' 30-day readmission rates decreased by 3.1 percentage points, and Shared Savings Program hospitals saw their rates drop by 4 percentage points. Thirty-day readmissions decreased at non-ACO hospitals by 2.9 percentage points in that same period, according to the study.
Relative readmission numbers within the first three days after discharge also decreased more at ACO-affiliated hospitals by a wide margin, according to the study. Rates were down 19.1% at the Pioneer and Shared Savings facilities, compared to 14.3% at non-ACO hospitals.
The team examined data from Medicare claims, comparing metropolitan hospitals that were affiliated with ACOs to those in the same regions that were not, limiting to urban hospitals as ACOs are uncommon in rural areas. Researchers studied data from more than 2,000 hospitals.
The researchers call for additional study into what exactly ACOs may be doing differently and what impact accountable care programs have on hospital discharge behaviors and care coordination between hospitals and SNFs. They noted that it’s becoming more common for hospitals to name certain skilled nursing facilities as “preferred providers,” which may also affect patient outcomes and readmission rates.
“Most of the difference in rehospitalization occurs zero to three days after discharge—that is, in the period when primary responsibility falls on care provided in the hospital,” the authors wrote. “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.”
ACOs have been on the hot seat as high-profile exits left their future in flux. However, research from CMS has found that ACOs have increased in quality on average throughout the program. Financial experts, though, are split on the financial benefits of ACOs.