The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study
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Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 4Duke Clinical Research Institute, Durham, NC, USA; 5Neurology, Massachusetts General Hospital, Boston, MA, USA; 6 Harvard Medical School, Boston, MA, USA; 7Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; 8Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
BACKGROUND: Post-stroke care delivery may be affected by provider participation in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) through systematic changes to discharge planning, care coordination, and transitional care. OBJECTIVE: To evaluate the association of MSSP with patient outcomes in the year following hospitalization for ischemic stroke. DESIGN: Retrospective cohort SETTING: Get With The Guidelines (GWTG)–Stroke (2010–2014) PARTICIPANTS: Hospitalizations for mild to moderate incident ischemic stroke were linked with Medicare claims for fee-for-service beneficiaries ≥ 65 years (N = 251,605). MAIN MEASURES: Outcomes included discharge to home, 30-day all-cause readmission, length of index hospital stay, days in the community (home-time) at 1 year, and 1-year recurrent stroke and mortality. A difference-in-differences design was used to compare outcomes before and after hospital MSSP implementation for patients (1) discharged from hospitals that chose to participate versus not participate in MSSP or (2) assigned to an MSSP ACO versus not or both. Unique estimates for 2013 and 2014 ACOs were generated. KEY RESULTS: For hospitals joining MSSP in 2013 or 2014, the probability of discharge to home decreased by 2.57 (95% confidence intervals (CI) = − 4.43, − 0.71) percentage points (pp) and 1.84 pp (CI = − 3.31, − 0.37), respectively, among beneficiaries not assigned to an MSSP ACO. Among discharges from hospitals joining MSSP in 2013, beneficiary ACO alignment versus not was associated with increased home discharge, reduced length of stay, and increased home-time. For patients discharged from hospitals joining MSSP in 2014, ACO alignment was not associated with changes in utilization. No association Prior Presentations These results were presented at the Academy Health Research Meeting on June 24, 2018, in Seattle, WA. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05283-1) contains supplementary material, which is available to authorized users. Received September 24, 2018 Revised April 10, 2019 Accepted July 25, 2019
between MSSP and recurrent stroke or mortality was observed. CONCLUSIONS: Among patients with mild to moderate ischemic stroke, meaningful reductions in acute care utilization were observed only for ACO-aligned beneficiaries who were also discharged from a hospital initiati
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