Relationship Between Accountable Care Organization Status and 30-Day Hospital-wide Readmissions. Are All Accountable Care Organizations Created Equal?

OBJECTIVE: We compare hospital readmission rates by accountable care organization (ACO) status with national readmission averages, to determine whether ACO affiliation influences 30-day hospital-wide readmission rates.

METHODS: Data from the 2015 American Hospital Association Survey of Care Systems and Payment database were merged with Centers for Medicare and Medicaid's 2015 Hospital Compare Deaths and Readmissions data set. A multinomial logistic regression model is used to examine readmission rates, categorized as better, no different, or worse, in comparison to national averages, by ACO status.

RESULTS: Compared with Non-ACO hospitals and holding the covariates constant, the relative risk of having better than national average readmissions was 1.85 in Medicare ACO hospitals (p = .36). Compared with facilities in the Northeast region, the relative risk of having better than national average readmissions was 2.21 for facilities in the West (p = .10). Facilities in the Midwest and Southern regions had a lower risk of having better than national average rates (Relative Risk: 0.90 and 0.23, respectively; p = .83 and .06, respectively). As hospital beds increase, facilities have significantly lower risks of having worse than national average readmissions.

CONCLUSIONS: Overall, the ACO status did not significantly improve readmissions. However, Medicare ACOs performed better than non-Medicare ACOs and those hospitals without any reported ACO arrangements.