Hospitals Affiliated With Medicare ACOs Decreased Readmission Rates Faster

After Medicare introduced readmission penalties, hospitals that were part of Medicare accountable care organizations (ACOs) reduced readmission rates of patients discharged to skilled nursing facilities more quickly than other hospitals. Researchers published their findings in the January issue of Health Affairs. 

Although the study found substantially reduced readmission rates for both ACO and non-ACO hospitals after the Medicare penalties went into effect, ACO hospitals measurably outpaced non-ACO hospitals in readmission drops. 

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

Over the study period, non-ACO hospitals reduced readmissions 13.1%, researchers found. In comparison, Pioneer ACOs cut readmissions 14.9% and Shared Savings ACOs 17.7%.

When researchers compared readmissions that occurred within the first 3 days after hospital discharge with longer-term readmissions between 4 and 30 days after discharge, they found a significant decline in readmissions in both periods (especially in ACO compared with non-ACO hospitals). Since early readmissions could suggest a lapse in hospital care and longer-term readmissions could signal a problem with skilled nursing facility care, the significant drops in both suggest both hospitals and skilled nursing facilities are improving at preventing readmissions, Dr Rahman said. He added that ACO-affiliated institutions are doing it better, though. 

The study also showed that the pace of readmission decreases quickened further in 2012 after the implementation of Medicare ACOs. 

One thing the study did not identify was how the hospitals and skilled nursing facilities improved their quality of care. A desire to avoid readmission penalties, however, combined with the prospect of keeping more of a bundled payment likely played a role.

“There is an additional incentive for ACO hospitals to coordinate the care of patients more efficiently,” Dr Rahman said.—Jolynn Tumolo