Do Medicare Accountable Care Organizations Impact Health Care Utilization among Long-Stay Nursing Home Residents?
Xiao Joyce Wang, Emmanuelle Belanger, Derek Lake and 4 others
PMID 39999953WHAT IT FOUND
Being attributed to a Medicare Accountable Care Organization did not significantly change hospitalizations, emergency visits, or costs for long-stay nursing home residents.
The reduction in spending seen over time occurred in both groups, suggesting broader reforms rather than ACOs drove the change.
Key findings
01Difference-in-differences models showed no statistically significant association between ACO attribution status and healthcare utilization or Medicare expenditure outcomes.
02ACO attribution was associated with a 0.6 percentage point increase in inpatient hospitalization, but this was not statistically significant (95% CI: -0.8, 2.0).
03Subgroup analyses for residents with dementia and those with intact cognition consistently showed a lack of statistically significant associations between ACO attribution and outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used a retrospective attribution algorithm for 2011 data, which may not perfectly capture how ACOs would have identified patients in real-time. The 'intention-to-treat' design may have biased estimates toward the null because some residents lost ACO attribution during the follow-up period. The study only examined utilization and expenditure outcomes, not patient-centered outcomes like quality of life, satisfaction, or burden of treatment. Changes in Tax Identification Numbers (TINs) for medical groups between 2011 and 2018 could have affected the accuracy of attribution comparisons.
Declared interests
Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural. No other specific conflicts of interest were declared in the provided text.
The easy way to misread this
Do not conclude that ACOs have no value for nursing home residents. The study found no impact on utilization and costs, but it did not measure patient-centered outcomes like quality of life or satisfaction. Additionally, the lack of impact may be due to the specific design and incentives of the ACO programs during the study period, not an inherent failure of the model.