Effects of accountable care organizations on post-acute care

急性后护理是美国医疗支出增长最快的领域之一。约40%的老年人 出院的美国人利用急性后护理，这方面的支出超过 在过去的十年里翻了一番。为了让提供者对纵向护理负责，联邦医疗保险正在测试 两个试点计划中的责任护理组织(ACO)：联邦医疗保险共享储蓄计划 (MSSP)和先锋ACO计划。这些努力对医疗保险支出和 然而，患者的结果仍然不确定。在某种程度上，急性后护理(PAC)支出 减少，了解是否通过减少数量或强度来降低成本 急性后护理，或者两者兼而有之，将是重要的。此外，ACO在他们的组织中有很大的不同 结构和风险模型(例如，较强的PAC参与度与较弱的PAC参与度；以及较多与较少的风险分担)。 PAC利用率的任何变化的幅度都将被ACO异质性所改变。分开 从ACOs对急性后护理利用和支出的影响来看，还有相当大的 不确定急性后护理的任何变化将如何影响关键的临床结果，如 死亡率。因此，我们建议利用全国医保数据来实现三个目标：1)评估 ACO对急性后护理支出和利用的影响；2)描述ACO的异质性 修改ACOS对急诊后护理支出的影响；以及3)评估急诊后医疗费用变化的影响 急性护理支出和利用对患者结局的影响。

Post-acute care is one of the fastest growing areas of US healthcare spending. About 40% of older Americans discharged from a hospital utilize post-acute care, and spending in this area has more than doubled in the past decade. To hold providers responsible for longitudinal care, Medicare is testing accountable care organizations (ACOs) in two pilot programs: the Medicare Shared Savings Program (MSSP) and the Pioneer ACO program. The impact of these efforts on both Medicare spending and patient outcomes remains uncertain, however. To the extent that post-acute care (PAC) spending is reduced, understanding whether lower costs occur through reductions in the quantity or intensity of post-acute care, or both, will be important. Furthermore, ACOs vary widely in their organizational structure and risk models (e.g., stronger vs. weaker PAC engagement; and more vs. less risk-sharing). The magnitude of any changes in PAC utilization will plausibly be modified by ACO heterogeneity. Apart from the effects of ACOs on post-acute care utilization and spending, there is also considerable uncertainty about how any changes in post-acute care will impact key clinical outcomes such as mortality. Therefore, we propose to use national Medicare data to carry out three aims: 1) To evaluate the impact of ACOs on post-acute care spending and utilization; 2) To describe how ACO heterogeneity modifies ACOs’ effects on post-acute care spending; and 3) To evaluate the impact of changes in post- acute care spending and utilization on patient outcomes.