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

Abstract

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. 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. 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. 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.