Background: Accountable care organizations through the Affordable Care Act are to improve Medicare beneficiaries' health while reducing costs. We hypothesize that this model may shift care, disease burden, and costs to nonaffiliated hospital facilities in patients with acute cholecystitis.
Methods: A retrospective difference-in-differences analysis was performed to compare severity, postoperative complications, diagnostic modality, length of stay, and costs in patients with acute cholecystitis from a post-accountable care organization implementation period (January 2014 through December 2015) to a pre-accountable care organization period (January 2011 through December 2012).
Results: Analysis of 400 patients with acute cholecystitis revealed the post-accountable care organization patients had significantly (P < .0001) higher disease severity (14.4% vs 8.4%), emergency admissions (90.1 vs 74.2%), computed tomography scans (55.5% vs 27.8%), prolonged length of stay (5.2 vs 3.9 days), and a 30% (P < .0003) increase in total costs.
Conclusion: These data are consistent with the hypothesis that the introduction of accountable care organizations resulted in a higher morbidity, more emergency admissions, more extensive management, a prolonged length of stay, and increased cost in patients with acute cholecystitis. These data support the position that accountable care organizations may shift costs from the primary care setting to nonaffiliated accountable care organization hospitals, provide a lesser level of care, and thus potentially failing their primary mandates.
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