The Impact of Accountable Care Organizations on Post Acute Care

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PROJECT SUMMARY The arrival of corona virus pandemic has had a dramatic and sudden impact on the healthcare system. In addition to the healthcare resources directly linked to the corona virus and those diagnosed with COVID-19, many hospitals have reduced their provision of non-emergent care and many patients have reduced their emergency department (ED) visits and hospitalizations for fear of contagion, and the presence of coronavirus in nursing homes and other rehabilitation facilities has reduced access to post-acute care. For many high-risk Medicare beneficiaries (in the oldest age groups, those with dementia, those with one or more chronic conditions, on dialysis or immunocompromised like those receiving chemotherapy) these reductions are likely to result in additional ED visits, hospitalizations and post-acute care once the pandemic pressure declines, and for some the delay will increase the severity of their condition making their treatment harder and negatively impacting their clinical outcomes. Accountable Care Organizations (ACOs), introduced in 2012 to incentivize the provision of coordinated high-quality care, have rapidly grown and as of January 2020 an estimated 11.2 million (26%) of the traditional Medicare fee-for-service (FFS) beneficiaries. The intended goal was to create groups of primary care doctors that—together with hospitals and other health care providers—would improve the coordination of care and reduce low-value care to increase the quality of care while reducing costs. This proposal seeks to provide quick evidence of the patterns of healthcare services utilization and some important clinical outcomes of Medicare FFS beneficiaries diagnosed with COVID-19, and of changes in utilization and outcomes of those diagnosed with COVID-19, paying particular attention to ED, hospitalizations and post-acute care, and to whether being assigned to an ACO has a protective effect. The proposed study will link ACO participation data, Medicare claims data and SNF, IRF and HHA assessment data across 2019-2020 to conduct a difference-in-differences analysis that examines the impact of COVID-19 on hospitalization and PAC utilization and the mediating effect of ACOs by pursuing the following specific aims: 1. Describe changes in ED, hospitalizations, ICU and mechanical ventilation utilization, pre/post pandemic of those diagnosed and not diagnosed with COVID-19, and by ACO assignment status. 2. Describe changes in PAC availability due to COVID-19 facility outbreaks and regional prevalence, and changes in hospital referral to PAC patterns for ACO and non-ACO beneficiaries and providers. 3. Characterize the SNF, IRF and HHA providers that had the largest changes in provision of PAC, and 4. Document changes in PAC episodes of care and patient outcomes following PAC discharge, including hospital readmissions, successful discharge to community, functional improvement and mortality rates among those who are and are not diagnosed with COVID-19, and by ACO status. The expected outcome of this research is to provide a timely understanding of the impact on COVID-19 on PAC utilization and outcomes, and the differences associated with ACO attribution.