Factors associated with hospital participation in Centers for Medicare and Medicaid Services' Accountable Care Organization programs.
Factors associated with hospital participation in Centers for Medicare and Medicaid Services' Accountable Care Organization programs.
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DOI：
10.1097/hmr.0000000000000182
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发表时间：
2019
影响因子：
2.5
通讯作者：
Deng Y
中科院分区：
文献类型：
--
作者：
Chukmaitov AS;Harless DW;Bazzoli GJ;Deng Y
2012年，医疗保险和医疗补助服务中心（CMS）启动了医疗保险共享储蓄计划（MSSP）和先锋责任医疗组织（ACO）计划。MSSP模式中的组织分享了他们通过CMS产生的成本节约，而先锋计划中的组织分享了节约和损失。很大程度上是未知的医院和环境的特点与发展的CMS ACO与单侧或双侧的风险模型。评估与医院参与MSSP和先锋ACO相关的组织和环境特征。参与CMS ACO计划的医院使用主要和次要数据进行识别。ACO医院样本与美国医院协会，健康信息和管理系统协会以及其他数据集相关联。估计多项概率模型，区分与医院参与MSSP和先锋ACO相关的组织和环境因素。医院参与CMS ACO计划与先前的经验与基于风险的支付和护理管理计划，先进的HIT，并在更高的收入和更具竞争力的地区的位置。虽然各种卫生系统类型与医院参与MSSP相关，但集中式卫生系统、紧密整合的POA中的医生数量较多以及初级保健医生供应较多的地区与先锋ACO相关。有利的医院特征，在总体上，更重要的是有利的环境因素MSSP参与。MSSP ACO可能会从参与医院中寻找更广泛的组织能力，这可能反映了参与不同市场的各种供应商。先锋ACO可能依赖于特定的医院和环境特征，以实现双边合同设定的质量和支出目标。医院和ACO领导者可以使用我们的结果来识别具有某些特征的医院，这些特征有利于他们参与单侧或双侧ACO。
In 2012, the Centers for Medicare and Medicaid Services (CMS) initiated the Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organization (ACO) programs. Organizations in the MSSP model shared cost savings they generated with CMS and those in the Pioneer program shared both savings and losses. It is largely unknown what hospital and environmental characteristics are associated with development of CMS ACOs with one-sided or two-sided risk models. To assess the organizational and environmental characteristics associated with hospital participation in MSSP and Pioneer ACOs. Hospitals participating in CMS ACO programs were identified using primary and secondary data. The ACO hospital sample was linked with the American Hospital Association, Health Information and Management System Society, and other datasets. Multinomial probit models were estimated that distinguished organizational and environmental factors associated with hospital participation in MSSP and Pioneer ACOs. Hospital participation in both CMS ACO programs was associated with prior experience with risk-based payments and care management programs, advanced HIT, and location in higher income and more competitive areas. While various health system types were associated with hospital participation in MSSP, centralized health systems, higher numbers of physicians in tightly integrated POAs, and location in areas with greater supply of primary care physicians were associated with Pioneer ACOs. Favorable hospital characteristics were, in the aggregate, more important than favorable environmental factors for MSSP participation. MSSP ACOs may look for broader organizational capabilities from participating hospitals that may be reflective of a wide range of providers participating in diverse markets. Pioneer ACOs may rely on specific hospital and environmental characteristics to achieve quality and spending targets set for two-sided contracts. Hospital and ACO leaders can use our results to identify hospitals with certain characteristics favorable to their participation in either one- or two-sided ACOs.