Medicare Accountable Care Organizations Not Linked to Lower Hospital Mortality Rates

Hospitals that are part of Medicare accountable care organizations (ACOs) may not have lower death rates for preventable conditions compared with hospitals that aren’t part of these ACOs, an AHRQ-funded study concluded. ACOs are groups of hospitals, physicians, health professionals and facilities that provide a range of coordinated services for a patient population. They have grown rapidly in recent years, especially Medicare ACOs, which are allowed under the Affordable Care Act. In this study, AHRQ researchers used the Agency’s Healthcare Cost and Utilization Project to analyze 2008-2014 discharge data from 34 states to compare mortality outcomes between Medicare ACOs and hospitals that did not join ACOs. They tracked outcomes for four conditions for which death is considered preventable with high-quality inpatient care: acute myocardial infarction, coronary artery bypass grafting, pneumonia, and abdominal aortic aneurysm repair. Researchers found that Medicare ACO and non-ACO hospitals had similar death rates for all conditions, suggesting that ACOs may not be improving quality across a full range of care needs. Access the abstract of the study published in the journal Inquiry.

2018 Jan-Dec;55:46958018800092. doi: 10.1177/0046958018800092.

The Effects of Medicare Accountable Organizations on Inpatient Mortality Rates.

Cutler E1, Karaca Z2, Henke R1, Head M1, Wong HS2.

Author information

Abstract

Studies have linked Accountable Care Organizations (ACOs) to improved primary care, but there is little research on how ACOs affect care in other settings. We examined whether Medicare ACOs have improved hospital quality of care, specifically focusing on preventable inpatient mortality. We used 2008-2014 Healthcare Cost and Utilization Project hospital discharge data from 34 states' Medicare ACO and non-ACO hospitals in conjunction with data from the American Hospital Association Annual Survey and the Survey of Care Systems and Payment. We estimated discharge-level logistic regression models that measured the relationship between ACO affiliation and mortality following admissions for acute myocardial infarction, abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting, and pneumonia, controlling for patient demographic mix, hospital, and year. Our results suggest that, on average, Medicare ACO hospitals are not associated with improved mortality rates for the studied IQI conditions. Stakeholders may potentially consider providing ACOs with incentives or designing new programs for ACOs to target inpatient mortality reductions.

KEYWORDS:

Accountable Care Organizations; Healthcare Cost and Utilization Project; Medicare; continuity of patient care; inpatients; logistic models; mortality; quality of health care