Abstract
Little is known about the impact of accountable care organizations (ACO) on hospitalized heart failure (HF) patients, a high-cost and high-risk population. Objective: We linked Medicare fee-for-service claims from 2013 to 2015 with data from American Heart Association Get With The Guidelines–HF registry to compare HF care, post-discharge outcomes, and total annual Medicare spending by ACO status at discharge. Methods: Using adjusted Cox models and accounting for competing risks of death, we compared all-cause mortality and readmission at 1 year by ACO status with reporting of hazard ratios (HR) and 99% confidence intervals (CI). Results: The study included 45,259 HF patients from 300 hospitals, with 21.1% assigned to an ACO. Patient characteristics were similar between the two groups with a few exceptions. The ACO patients lived in geographic areas with higher median income ($54400 [IQR $48600-65900] vs $52300 [$45900-61200], P < .0001). Compliance with four HF-specific quality measures was modestly higher in the ACO group (80% vs 76%, P < .0001). In adjusted analysis, ACO status was associated with similar all-cause readmission (HR: 1.03; 99% CI: 0.99, 1.07) but lower risk of 1-year mortality (HR: 0.85; 99% CI: 0.85, 0.90) compared with non-ACO status. Median Medicare spending in the calendar year of hospitalization was similar (ACO $42,737 [IQR $23,011-72,667] vs non-ACO $42,586 [$22,896-72,518], P = 0.06). Conclusions: Among Medicare patients hospitalized for HF, participation in an ACO was associated with similar rates of all-cause readmission and no associated cost reductions compared with non-ACO status. There was a lower risk of 1-year mortality associated with ACO participation, which warrants further evaluation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 13-23 |
| Number of pages | 11 |
| Journal | American heart journal |
| Volume | 226 |
| DOIs | |
| State | Published - Aug 2020 |
Funding
This project was funded by a Young Investigator Database Research Seed Grant from the GWTG-HF program. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. This project was funded by a Young Investigator Database Research Seed Grant from the Get With The Guidelines®–Heart Failure (GWTG-HF) program. The GWTG-HF program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. This project was funded by a Young Investigator Database Research Seed Grant from the Get With The Guidelines??Heart Failure (GWTG-HF) program. The GWTG-HF program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Nancy Luo and Robert Mentz had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Disclosures: NL: Consulting AstraZeneca ADD: Research funding from AstraZeneca, Amgen, the American Heart Association, Bayer, Luitpold Pharmaceuticals, the NHLBI, PCORI and Novartis; Consulting with AstraZeneca, LivaNova, Mardil Medical, Novartis and Procyrion. GCF: Consulting Abbott, Amgen, Bayer, Janssen, Medtronic, Novartis AFH: Research funding from American Regent, AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Merck, Novartis, Verily; Consulting with AstraZeneca, Bayer, Boehringer-Ingelheim, Boston Scientific, Merck and Novartis All other authors report no significant disclosures.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine