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The impact of accountable care organization participation on hospital patient experience

Diana, Mark L.; Zhang, Yongkang; Yeager, Valerie A.; Stoecker, Charles; Counts, Catherine R.

doi: 10.1097/HMR.0000000000000219

Background: Accountable care organizations (ACOs) are being implemented rapidly across the Unites States. Previous studies indicated an increasing number of hospitals have participated in ACOs. However, little is known about how ACO participation could influence hospitals’ performance.

Purpose: This study aims to examine the impact of Medicare ACO participation on hospitals’ patient experience.

Methodology/Approach: Difference-in-difference analyses were conducted to compare 10 patient experience measures between hospitals participating in Medicare ACOs and those not participating.

Results: In general, hospitals participating in Pioneer ACOs had significantly improved scores on nursing communication and doctor communication. Shared Savings Program (SSP) ACO participation did not show significant improvement of patient experience. Subgroup analyses indicate that, for hospitals in the middle and top tertile groups in terms of baseline experience, Pioneer ACO and SSP ACO participation was associated with better patient experience. For hospitals in the bottom tertile, Pioneer ACO and SSP ACO participation had no association with patient experience.

Conclusion: ACO participation improved some aspects of patient experience among hospitals with prior good performance. However, hospitals with historically poor performance did not benefit from ACO participation.

Practice Implications: Prior care coordination and quality improvement experience position Medicare ACOs for greater success in terms of patient experience. Hospital leaders need to consider the potential negative consequences of ACO participation and the hospital’s preparedness for care coordination.

Mark L. Diana, PhD, is Associate Professor and Chair, Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. E-mail:

Yongkang Zhang, PhD, is Post-Doctoral Associate, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York.

Valerie A. Yeager, DrPH, is Associate Professor, Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis.

Charles Stoecker, PhD, is Assistant Professor, Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.

Catherine R. Counts, PhD, is Senior Fellow, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.

The authors received no financial support for the research, authorship, and/or publication of this article.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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