Inclusion of Nursing Homes and Long-term Residents in Medicare ACOs

Abstract

Long-term nursing home residents have complex needs that often require services from acute care settings. The accountable care organization (ACO) model provides an opportunity to improve care by creating payment incentives for more coordinated, higher quality care. To assess the extent of nursing home participation in ACOs, and the characteristics of residents and their nursing homes connected to ACOs. This was a cross-sectional study. Medicare nursing home residents identified from 2014 Minimum Data Set assessments. Residents were attributed to ACOs based on Medicare methods. Individuals' demographics, clinical characteristics, health care utilization, and nursing home characteristics. Among 660,780 nursing home residents, a quarter of them were attributed to ACOs. ACO residents had only small differences from non-ACO residents: age 85 years and older (47.1% vs. 45.3%), % black (10.5% vs. 12.7%), % dual eligible (74.3% vs. 75.8%), and emergency department visits (55.1 vs. 57.3 per 100). Of the 14,868 nursing homes with study residents, few were ACO providers (N=222, 1.6% of total residents) yet many had at least one ACO resident (N=8077, 76.4% of total residents); one-fifth had at least 20 (N=2839, 33.4% of total residents). ACO-provider homes were more likely than other homes to have a 5-star rating, be hospital-based and have Medicare as the primary payer. With a quarter of long-term nursing home residents attributed to an ACO, and one-fifth of nursing homes caring for a large number of ACO residents, outcomes and spending in this setting are important for ACOs to consider when designing patient care strategies.