The Effects of Accountable Care Organizations Forming Preferred Skilled Nursing Facility Networks on Market Share, Patient Composition, and Outcomes

Jing Gu, Peter Huckfeldt, Neeraj Sood

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Through participation in payment reforms such as bundled payment and accountable care organizations (ACOs), hospitals are increasingly financially responsible for health care use and adverse health events occurring after hospital discharge. To improve management and coordination of postdischarge care, ACO hospitals are establishing a closer relationship with skilled nursing facilities (SNFs) through the formation of preferred SNF networks. Research Design: We evaluated the effects of preferred SNF network formation on care patterns and outcomes. We included 10 ACOs that established preferred SNF networks between 2014 and 2015 in the sample. We first investigated whether hospitals "steer" patients to preferred SNFs by examining the percentage of patients sent to preferred SNFs within each hospital before and after network formation. We then used a difference-in-difference model with SNF fixed effects to evaluate the changes in patient composition and outcomes of preferred SNF patients from ACO hospitals after network formation relative to patients from other hospitals. Results: We found that preferred network formation was not associated with higher market share or better outcomes for preferred SNF patients from ACO hospitals. However, we found a small increase in the average number of Elixhauser comorbidities for patients from ACO hospitals after network formation, relative to patients from non-ACO hospitals. Conclusions: After preferred SNF network formation, there is some evidence that ACO hospitals sent more complex patients to preferred SNFs, but there was no change in the volume of patients received by these SNFs. Furthermore, preferred network formation was not associated with improvement in patient outcomes.

Original languageEnglish (US)
Pages (from-to)354-361
Number of pages8
JournalMedical care
Volume59
Issue number4
DOIs
StatePublished - Apr 1 2021
Externally publishedYes

Bibliographical note

Funding Information:
From the *School of Pharmacy, University of Southern California, Los Angeles, CA; †School of Public Health, University of Minnesota, Minneapolis, MN; and ‡Sol Price School of Public Policy, University of Southern California, Los Angeles, CA. Supported by the National Institute on Aging (Grant No. R01 AG-046838). The authors declare no conflict of interest. Correspondence to: Neeraj Sood, PhD, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089. E-mail: nsood@healthpolicy.usc.edu. Supplemental Digital Content is available for this article. Direct URL cita-tions appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.lww-medicalcare. com. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0025-7079/21/5904-0354

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • accountable care organizations
  • costs
  • patient outcomes
  • skilled nursing facilities
  • vertical integration

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