Hofler Richard, Ortiz Judith, Coté Brian
College of Business Administration, Department of Economics, University of Central Florida, P.O. Box 161400, Orlando, FL 32816-1400, U.S.,
College of Health and Public Affairs, University of Central Florida, P.O. Box 162369, Orlando, FL 32816, U.S.,
J Health Care Finance. 2018 Winter;44(3).
The purpose of this study is to examine the costs related to practice transformation from the perspective of primary care organizations transitioning to become participants in Accountable Care Organizations (ACOs). We pose two research questions: 1) Will a Rural Health Clinic that participates in an Accountable Care Organization see higher or lower cost per visit, and 2) If the cost per visit is higher or lower, how large will that difference be? We analyze administrative data from a panel of over 800 Rural Health Clinics for the period 2007 - 2013 using a treatment effects approach, where a clinic's participation in an ACO is viewed as a "treatment." Since the first year that an RHC could join an ACO was 2012 and our most recent year of complete data is 2013, we restricted our analysis of the impact of participation in an ACO to include only 2012 and 2013 data. The estimates of the average treatment effect on the treated (ATET) pertain to only those RHCs that joined ACOs. The results show that those 20 sample ACO RHCs experienced an average from $15.00 to $18.61 higher cost per visit than the matching non-ACO RHCs. At this very early stage of ACO development, our results must be considered very preliminary at best. Whatever conclusions we draw from these results are intended to merely suggest what might be found once many more RHCs join ACOs. The conclusions we draw from this early analysis can lay a foundation for more analysis after data are available when more RHCs join ACOs.
本研究的目的是从向负责医疗组织（ACO）转变的基层医疗组织的角度，考察与实践转变相关的成本。我们提出两个研究问题：1）参与负责医疗组织的农村健康诊所每次就诊的成本会更高还是更低？2）如果每次就诊成本更高或更低，差异会有多大？我们使用一种处理效应方法，分析了2007年至2013年期间800多家农村健康诊所的行政数据，其中诊所参与ACO被视为一种“处理”。由于农村健康诊所最早可加入ACO的年份是2012年，而我们有完整数据的最近一年是2013年，因此我们将对参与ACO影响的分析仅限于2012年和2013年的数据。对处理组的平均处理效应（ATET）估计仅适用于那些加入ACO的农村健康诊所。结果显示，这20家样本ACO农村健康诊所每次就诊的成本比匹配的非ACO农村健康诊所平均高出15.00美元至18.61美元。在ACO发展的这个非常早期阶段，我们的结果充其量只能被视为非常初步的。无论我们从这些结果中得出什么结论，都只是为了表明当更多农村健康诊所加入ACO时可能会发现什么。我们从这一早期分析中得出的结论可以为更多农村健康诊所加入ACO后有数据时进行的更多分析奠定基础。
