Early Impact of Medicare Accountable Care Organizations on Inpatient Surgical Spending

Annals of Surgery
Hari NathanJustin B. Dimick

Abstract

To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown. We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]. We compared total Medicare payments for 30-day surgical episodes, payments for individual components of care (index hospitalization, readmissions, physician services, and postacute care), and clinical outcomes for patients treated at MSSP ACO hospitals versus matched controls at non-ACO hospitals. We accounted for preexisting trends independent of ACO participation using a difference-in-differences approach. Among 341,675 patients at 427 ACO hospitals and 1,024,090 matched controls at 1531 non-ACO hospitals, patient and hospital characteristics were well-balanced. Average baseline pay...Continue Reading

References

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Citations

Oct 11, 2019·Annals of Surgery·Joshua M Liao, Amol S Navathe
Apr 3, 2020·Annual Review of Public Health·Joshua M LiaoRachel M Werner
Jul 11, 2019·Journal of Surgical Oncology·Anghela Z ParedesTimothy M Pawlik
Jul 22, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Kota SaharaTimothy M Pawlik
Jul 18, 2020·Annals of Surgery·Kushal T KadakiaAnaeze C Offodile
Jan 5, 2019·Annals of Surgical Oncology·Bradley N ReamesChandrakanth Are
Oct 31, 2020·Journal of the American College of Surgeons·Parth K ModiBrent K Hollenbeck
Jan 11, 2021·The Journal of Surgical Research·Anghela Z ParedesTimothy M Pawlik
Mar 1, 2021·The Journal of Surgical Research·Pooja U NeimanJohn W Scott
Jun 22, 2021·The Journal of Surgical Research·Alison S BaskinLesly A Dossett

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