Replication Data for: Changes in Use of Postacute Care Associated With Accountable Care Organizations in Hip Fracture, Stroke, and Pneumonia Hospitalized Cohorts

<p><b>Objective:</b> To examine changes in more and less discretionary
condition-specific postacute care use (skilled nursing, inpatient rehabilitation,
home health) associated with Medicare accountable care
organization (ACO) implementation.</p>

<p><b>Data Sources:</b> 2009–2014 Medicare fee-for-service claims.</p>

<p><b>Study Design:</b> Difference-in-difference methodology comparing
postacute outcomes after hospitalization for hip fracture and stroke
(where rehabilitation is fundamental to the episode of care) to
pneumonia, (where it is more discretionary) for beneficiaries attributed
to ACO and non-ACO providers.</p>

<p><b>Principal Findings:</b> Across all 3 cohorts, in the baseline period
ACO patients were more likely to receive Medicare-paid postacute
care and had higher episode spending. In hip fracture patients where
rehabilitation is standard of care, ACO implementation was associated
with 6%–8% increases in probability of admission to a skilled
nursing facility or inpatient rehabilitation (compared with home
without care), and a slight reduction in readmissions. In a clinical
condition where rehabilitation is more discretionary, pneumonia,
ACO implementation was not associated with changes in postacute
location, but episodic spending decreased 2%–3%. Spending decreases
were concentrated in the least complex patients. Across all
cohorts, the length of stay in skilled nursing facilities decreased with
ACO implementation.</p>