Hospitals affiliated with ACOs reduced rehospitalizations from SNFs

Published results showed hospitals associated with accountable care organizations reduced patient rehospitalizations from skilled nursing facilities more rapidly than hospitals not associated with those organizations.

Investigators noted, however, this does not necessarily mean when a hospital joins an accountable care organization (ACO) it will have a reduced rate of rehospitalizations from skilled nursing facilities (SNFs).

“The take home message … is ACO-affiliated hospitals reduced rehospitalizations from SNFs at a faster rate than other hospitals,” Momotazur Rahman, PhD, assistant professor at Brown University School of Public Health, told Orthopedics Today.

Rahman and his colleagues identified all Medicare fee-for-service beneficiaries discharged directly from either Medicare Pioneer and Shared Savings programs, which were the ACO-affiliated hospitals, or from general hospitals that did not participate in those programs to a SNF in metropolitan areas for postacute care between January 2007 to November 2013. The main outcome measure was an indicator variable of 30-day rehospitalization.

While results showed a slightly higher proportion of patients were discharged to SNFs from ACO-affiliated hospitals, a rate that increased over time at a higher rate among Pioneer hospitals, there was also a lower rehospitalization rate among Pioneer hospitals than non-ACO-affiliated and Shared Savings program hospitals.

“All three types of hospital experienced declining rehospitalization rates after 2010,” the authors wrote.

During the study period, rehospitalizations within 30 days were reduced by 3.1% for Pioneer hospitals, 4% for Shared Savings program hospitals and 2.9% for non-ACO-affiliated hospitals. Both types of ACO-affiliated hospitals demonstrated a larger decrease in rehospitalization rates from SNFs within 30 days vs. non-ACO-affiliated hospitals with a relative reduction of 17.1% for Shared Savings hospitals, 14.9% for Pioneer hospitals and 13.1% for non-ACO-affiliated hospitals, according to results. Researchers also found a 19.1% relative reduction in rehospitalizations from SNFs within the first 3 days among ACO-affiliated hospitals vs. 14.3% among non-ACO-affiliated hospitals.

Rahman said ACO-affiliated status does not necessarily mean the hospital will have a reduction in rehospitalizations. Hospitals that join ACOs are “probably doing something that reduces their rehospitalization rate at a faster rate,” he said.

“The main limitation is that… this is not a causal inference,” he said. “We cannot say that if a random hospital decides to join [an] ACO, that would not necessarily mean it will reduce the rehospitalization rate. It is rather the other way around.”

A next step would be to identify the type of SNFs to which ACO-affiliated hospitals choose to send patients, Rahman said.

“ACO hospitals may … steer their patients toward high performing nursing homes or their most preferred nursing homes at a higher rate than other hospitals,” he said. “This is like managing postoperative care and ACO hospitals are accountable for any expenses during postoperative care. So, that makes a lot of sense that they can have a more active role in terms of nursing home choice and also length of nursing home stay.” – by Casey Tingle

Reference:

Wimbled U, et al. Health Affairs. 2017;doi:10.1377/hkthaff.2016.0759.

For more information:

Momotazur Rahman, PhD, can be reached at Brown University School of Public Health, 121 S. Main St., Providence, RI 02903; email: momotazur_rahman@brown.edu.

Disclosure: Rahman reports no relevant financial disclosures.