Large hospitals are more likely to have a contract with an accountable care organization, and those participating in ACOs were more likely to be in heavily-populated urban areas, new findings from the Dartmouth Institute for Health Policy and Clinical Practice revealed.
The study's authors, Carrie Colla, Valerie Lewis, Emily Tierney and David Muhlestein, used data from the National Survey of Accountable Care Organizations and the Leavitt Partners ACO Database to determine whether hospitals participating in ACOs differed from those that did not. Published in the March issue of Health Affairs, the study utilized interviews with ACO personnel -- predominantly chief medical officers -- to examine the advantages and disadvantages of participating in an ACO.
ACOs are groups of providers that are collectively held responsible for the care of a defined population of patients, and the study's authors state that the extent to which ACOs involve hospitals in their operations may prove crucial, because "managing hospital care is a key part of improving healthcare quality and lowering cost growth."
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Twenty percent of American hospitals were part of an ACO in 2014, researchers found, and they were least likely to be in more rural areas, with more than two-thirds located in the Eastern or Pacific regions. For those in an ACO, 13 percent of the population in the hospital's catchment area had incomes under the federal poverty level, compared to 16 percent for hospitals not participating in an ACO.
Eighty-five percent of ACO facilities were short-term acute care hospitals, rather than specialty or critical access hospitals, researchers discovered. Additionally, teaching hospitals and those offering a greater number of services -- such as obstetrics and intensive care -- were more likely to participate in ACOs, compared to non-teaching hospitals and those that offered fewer services.
The authors also highlighted some advantages of including a hospital in an ACO. Most representatives of ACOs with a hospital reported that the hospital was an advantageous source of capital. Another strategic advantage of hospital participation included patient data sharing between inpatient and outpatient settings, such as discharge summaries or alerts to an emergency admission, as well as the ability to align financial incentives across care settings to regulate costs and ensure quality.
Researchers concluded that policymakers have the ability to negate some of the perceived disadvantages of forming an ACO without a hospital by providing access to capital and support for implementing health information exchange systems.
They also said that, for ACOs to meet quality and cost goals, it will be "important to ensure broader and more consistent participation of different types of providers in the model."