ACOs that include hospitals vs. those that don't: 7 comparisons

While more than half of accountable care organization provider networks include hospitals, whether or not an ACO includes hospitals does not appear to affect its ability to manage hospital-related aspects of patient care, according to a study from The Commonwealth Fund.

Researchers analyzed data from 269 ACOs that responded to the National Survey of Accountable Care Organizations between October 2012 and March 2014, as well as information from Leavitt Partners' ACO database. They supplemented this analysis with interviews and site visits to more closely examine ACO characteristics, identify the types of hospitals that participate in ACO networks and examine the differences that hospital participation makes in ACOs' ability control costs, according to the report.

Here are seven key findings from The Commonwealth Fund.

1. While more than half of ACOs include a hospital, 20 percent of all U.S. hospitals participate in an ACO. About 10 percent participate in one of Medicare's ACO programs.

2. The hospitals most likely to participate in an ACO are those in heavily populated urban areas or those with a smaller share of Medicare patients, compared with hospitals in rural areas or those with a high proportion of Medicare patients.

3. Hospitals that offer a wide array of services — such as obstetrics and intensive care — as well as teaching hospitals are more likely to participate in an ACO than nonteaching hospitals and those that offer fewer services.

4. The vast majority — 85 percent — of hospitals involved in ACOs are short-term acute care facilities, while 12 percent are critical access hospitals and 3 percent are specialty hospitals.

5. The patients that receive care from hospitals that belong to ACOs are typically sicker and have longer lengths of stay than patients in nonparticipating hospitals, which suggests ACOs have more medically complex patients than other hospitals. The study authors did not identify any significant differences between participating and nonparticipating hospitals in terms of readmissions or serious complications.

6. ACOs that include hospitals have twice as many full-time-equivalent primary care clinicians and more than three times as many specialty physicians as ACOs without hospitals.

7. Although the 63 percent of ACOs that include hospitals offer more comprehensive services than those that don't, there is no significant difference between the two ACO groups in their ability to manage hospital-related aspects of patient care.

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