Of the early Medicare accountable care organizations — those that joined the program before fall 2012 — just 46 percent involved a hospital, according to new analysis from The Commonwealth Fund.
In the report “Analysis of Early Accountable Care Organizations Defines Patient, Structural, Cost, and Quality-of-Care Characteristics,” researchers analyzed early Medicare ACOs to collect baseline information on patient populations, quality and costs.
They found the following characteristics:
• Large, nonprofit teaching hospitals were the typical hospital participating in an ACO.
• There was little difference between participating and nonparticipating hospitals in performance on quality metrics.
• Hospital referral regions with ACOs tended to have larger populations and more Medicare spending per beneficiary.
• Patients in ACOs were more likely to be white, older than 80 years old and have higher incomes than other Medicare beneficiaries.
• ACO patients had 5.8 percent lower total costs of care ($7,694) than patients not in an ACO ($8,164) at the baseline.
The report's authors speculated the reason less than half of the ACOs had a hospital participant is because of hospitals' “inherent pressure to fill beds,” and the ambulatory care providers were reluctant to include hospitals in their ACOs. The authors concluded it is important to monitor how ACOs that include hospitals perform against ACOs without.