Impact Of Accountable Care Organizations On Acute Cholecystitis Outcomes In The Rio Grande Valley
Robert Armour Forse
DHR Health, Edinburg, TX
Objective: Accountable care organizations (ACO) are a signature reform of the Affordable Care Act intended to create a system that improves the health of Medicare beneficiaries by providing quality care while reducing costs by avoiding unnecessary duplication of services in the primary care setting. We hypothesize that this model causes a shift in costs to hospital facilities by requiring an extensive diagnostic workup and alternative surgical therapy in patients with acute cholecystitis. Methods: A difference-in-differences analysis was performed on a retrospective cohort to compare severity scales, postoperative complication rate, diagnostic imaging modality, and length of stay in patients with acute cholecystitis from a post-ACO implementation two year period to a pre-ACO two year period. Results: The study comprised of Analysis of 400 patients with acute cholecystitis (198 pre-ACO and 202 post-ACO patients). As compared to the pre-ACO group, the post-ACO patients had significantly (P<0.01) higher rates of disease severity (14.4% vs 8.4%), emergency admissions (90.1% vs 74.2% ), CT scan use (55.5% vs 27.8%), ICU admission (7.92% vs 1.52%), choledocolithiasis (17.56% vs 8.33%) and prolonged length of stay (5.2 days vs 3.9 days). Conclusion: This study confirms that patients with acute cholecystitis in the post-ACO period were found to have a higher morbidity, required more emergency room admissions, and more extensive management, with a prolonged length of stay, when compared with the control group. This data supports the position that ACOs shift costs from the primary care setting to non-affiliated ACO hospitals, and provide patients with an overall lesser level of care.
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