Hospitals that participate in accountable care organizations (ACOs) are significantly more likely than other hospitals to use several quality improvement programs, according to a study in the January-March issue of Quality Management in Health Care. Hospitals affiliated with an ACO are also much more likely to have the ability to track patient readmissions within the organization and beyond.
The study was based on 2013 data from 899 hospitals, 37 percent of which belonged to an ACO. Here’s a closer look at what the study reveals about how ACO hospitals differ from their non-ACO counterparts when it comes to quality improvement and patient tracking.
QI TOOL DIFFERENCES
About 65 percent of non-ACO hospitals used only one quality improvement (QI) tool, researchers found. Comparatively, nearly 57 percent of ACO hospitals used two, three or even four QI tools to address performance shortcomings.
“ACO hospitals may be taking advantage of synergies among QI tools, as the use of multiple QI programs may better equip hospitals to tailor these strategies when performance gaps are identified,” observed study authors Arthur M. Mora, PhD, Tulane University School of Public Health and Tropical Medicine, New Orleans, and Daniel Walker, PhD, Ohio State University Wexner Medical Center, Columbus, OH.
Because ACO hospitals have a strong financial incentive — shared savings — to reduce costs and achieve quality thresholds, their interest in QI programs makes sense. What the study doesn’t probe, however, is whether the opportunity to participate in an ACO attracted hospitals with a pre-existing enthusiasm for all things QI or whether ACO membership inspired their subsequent interest in numerous QI programs.
“Alternatively, the lack of causal design in this study leaves open the possibility that non-ACO hospitals choose not to join ACOs due to their inexperience with QI tools or perceived lack of ability to bring about QI,” the authors wrote.
PATIENT TRACKING DIFFERENCES
The study also revealed that ACO hospitals were significantly more likely than non-ACO hospitals to have the ability to detect readmissions (34 percent vs. 23 percent) and track them (91 percent vs. 86 percent) within and across organizational boundaries.
“This finding may indicate that ACO hospitals recognize the importance of being able to identify performance gaps through sophisticated measurement capabilities,” researchers wrote. “These capabilities enable hospitals not only to improve care coordination across the care continuum but also to identify consistent subpar performance emanating from particular service lines and to better manage patients with frequent admissions and other health care utilization.”
Still, Dr. Mora and Dr. Walker drew attention to the finding that just a third of ACO hospitals had the ability to detect readmissions. That means most ACOs may be at a disadvantage when it comes to meeting quality benchmarks and obtaining shared savings, they mused.
WHAT’S THE EFFECT ON OUTCOMES?
Although the study provides an interesting look at how hospitals’ QI strategies and readmission tracking capabilities differ according to ACO participation status, researchers can’t tell us — at least not yet —if and how these differences affect patient outcomes.
But as ACOs get a performance history under their belts, this is one aspect that will likely be investigated, researchers predicted.
“It is unclear whether these differences lead to clinically significant outcomes in patient care,” the authors wrote. “As the survey is continued in subsequent years, a longitudinal data set will allow for further analysis to assess the effect of QI tool(s) on clinical, financial and operational outcomes.”
What do you think? Are hospitals with robust QI approaches drawn to the financial incentives of the ACO model, or is ACO participation prompting their enthusiasm for serious QI efforts?