Nav: Home

Hospitals in Medicare ACOs reduced readmissions faster

January 09, 2017

PROVIDENCE, R.I. [Brown University] -- Hospitals in Medicare Accountable Care Organizations outpaced non-ACO hospitals in reducing the rate at which patients discharged to skilled nursing facilities (SNFs) needed to return to the hospital, according to a new study in the January issue of Health Affairs.

When a hospital sends a patient to a nursing home, everyone's hope is that the patient won't have to resume acute care back at the hospital, though until recently about 1 in 4 did. To drive the rate down, Medicare has implemented measures including penalties for excess readmissions and encouraging hospitals to join ACOs in which they share an overall "bundled" payment with SNFs. This model gives providers the incentive that they can keep more profit if they reduce expensive extra hospital care.

The new study suggests that while all hospitals reduced their readmission rates following the adoption of readmission penalties, ACO hospitals reduced them at a faster rate.

"This is about understanding whether ACOs work or not," said Momotazur Rahman, a study co-author and assistant professor at the Brown University School of Public Health. "It seems like they are doing slightly but significantly better than non-ACO hospitals."

Faster dropping rates

To perform the study, the researchers gathered information on discharges and readmissions between 2007 and 2013 from 220 ACO-affiliated hospitals and more than 1,840 non-ACO hospitals in metropolitan areas around the country. They also had anonymized medical and demographic data on all the patients involved so they could statistically control for such factors in comparing ACO vs. non-ACO readmission rates.

They chose the study timeframe to straddle passage of the Affordable Care Act in 2010 and implementation of two variants of ACOs in 2012, "Pioneer" and "Shared Savings." In this way they could not only compare the readmission rates of different hospital types to each other, but also how each hospital type's readmission rate changed before and after Medicare's measures took effect.

They found that both ACO and non-ACO hospitals have succeeded on average in substantially reducing readmission rates, but that ACO hospitals have been measurably better. Over the entire period, relative to their readmission rate in 2007, non-ACO hospitals reduced readmissions by 13.1 percent, while hospitals in Pioneer ACOs reduced them by 14.9 percent and Shared Savings ACOs reduced them by 17.7 percent.

To gain further insights, the team analyzed the data in a few other ways. For example, they separated out quick readmissions (within the first three days after discharge) and longer-term ones (four to 30 days after). The reason, Rahman said, was that quick readmissions might reflect lapses in hospital care while longer-term ones might reflect lapses in SNF care. The analysis showed that readmissions declined significantly in both periods (not only overall but especially in ACOs vs. non-ACOs comparisons), suggesting that both hospitals and SNFs are improving their readmission prevention and that ACO-affiliated institutions are doing so more.

Another analysis showed that the pace of readmission reductions quickened further after the implementation of ACOs in 2012, suggesting that the policy really did make a difference.

Exactly how that difference occurred is not clear. The team did not see evidence in the data that hospitals became more selective about discharging patients to more capable SNFs, Rahman said. The data can't say how hospitals and SNFs improved their care quality, or whether the two types of institutions improved communication about patients.

But the prospect of not only avoiding reimbursement penalties but also keeping more of a bundled payment appears to have a real effect on reducing readmissions, the authors wrote.

"There is an additional incentive for ACO hospitals to coordinate the care of patients more efficiently," Rahman said.

Co-author John McHugh, a Brown graduate alumnus, agreed.

"Hospitals have historically had no incentive to coordinate care management efforts with post-acute providers," said McHugh, now an assistant professor of Health Policy and Management at Columbia University's Mailman School of Public Health. "This highlights one area in which the ACO incentive structure may be working to improve outcomes for skilled nursing facility patients."
-end-
The study's lead author is Ulrika Winblad, an associate professor at Uppsala University in Sweden who was a Harkness Fellow at Brown during the 2014-15 academic year. In addition to Winblad, Rahman, and McHugh the paper's other authors are Brown Professor Vince Mor.

Brown University

Related Public Health Articles:

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.
Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.
Bloomberg American Health Initiative releases special public health reports supplement
With US life expectancy now on the decline for two consecutive years, the Bloomberg American Health Initiative is releasing a supplement to Public Health Reports, the scholarly journal of the US Surgeon General.
Data does the heavy lifting: Encouraging new public health approaches to promote the health benefits of muscle-strengthening exercise (MSE)
According to a new study in the American Journal of Preventive Medicine, almost 75 percent of US adults do not comply with public health guidelines recommending two or more muscle-strengthening exercise (MSE) sessions a week, with nearly 60 percent of the population doing no MSE at all.
The Lancet Public Health: Moderate carbohydrate intake may be best for health
Low-carb diets that replace carbohydrates with proteins and fats from plant sources associated with lower risk of mortality compared to those that replace carbohydrates with proteins and fat from animal sources.
Mass. public safety, public health agencies collaborate to address the opioid epidemic
A new study shows that public health and public safety agencies established local, collaborative programs in Massachusetts to connect overdose survivors and their personal networks with addiction treatment, harm reduction, and other community support services following a non-fatal overdose.
Cyber attacks can threaten public health
Gordon and Landman have authored a Perspective piece in the New England Journal of Medicine that addresses the growing threat of attacks on information systems and the potential implications on public health.
Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
More Public Health News and Public Health Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.