Evaluating Accountable Care Organizations impact on gastrointestinal cancer care: are they falling short on health outcomes?

Abstract

Background

Accountable Care Organizations (ACOs) have emerged as a value-based care model. However, the effect on gastrointestinal (GI) cancer care remains poorly defined. Therefore, the current study aimed to investigate the effect of hospital ACO participation on surgical and financial outcomes.

Methods

Patients who underwent GI cancer surgery between 2016 and 2020 were identified from the Medicare Standard Analytic Files. Difference-in-differences (DID) analysis was performed to examine the effect of hospital ACO participation on surgical outcomes and healthcare expenditures.

Results

A total of 23,357 beneficiaries underwent GI cancer surgery at 2180 hospitals (ACO participating: 57 [2.7%]). The median patient age was 75 years (IQR, 71–81). Moreover, most patients were female (12,207 [52.3%]) and had a Charlson Comorbidity Index score of >2 (14,067 [54.3%]). On DID analysis, after adjusting for patient and hospital baseline characteristics, ACO participation was not associated with a reduced risk of complications during the index hospitalization (RRR [relative risk ratio], 1.03 [95% CI, 0.90–1.18]; P =.71), extended length of stay (RRR, 1.04 [95% CI, 0.92–1.67]; P =.52), 30-day complication (RRR, 1.96 [95% CI, 0.72–1.27]; P =.77), 30-day readmission (RRR, 1.07 [95% CI, 0.92–1.25]; P =.96), or 30-day mortality (RRR, 0.96 [95% CI, 0.77–1.21]; P =.74). Moreover, ACO participation was not associated with reduced healthcare costs.

Conclusion

Hospital participation in ACOs was not associated with improved surgical outcomes or reduced healthcare costs. There is a need for nuanced, targeted interventions within the ACO framework that address the unique needs of complex surgical patients.