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OBJECTIVE: To evaluate the impact of hospitals participation in the Medicare Shared Savings Program (MSSP) on their financial performance. DATA SOURCES: Centers for Medicare & Medicaid Services Hospital Cost Reports and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2011 to 2018. STUDY DESIGN: We used an event-study design to estimate the temporal effects of MSSP participation on hospital financial outcomes and compared within-hospital changes over time between MSSP and non-MSSP hospitals while controlling for hospital and year fixed effects and organizational and service-area characteristics. The following financial outcomes were evaluated: outpatient revenue, inpatient revenue, net patient revenue, Medicare revenue, operating margin, inpatient revenue share, Medicare revenue share, and allowance and discount rate. DATA COLLECTION/EXTRACTION METHODS: Secondary data linked at the hospital level. PRINCIPAL FINDINGS: Controlling for trends in non-MSSP hospitals, MSSP participation was associated with differential increases in net patient revenue by $3.28 million (p

BackgroundThis study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs' 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group.MethodsThe research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates.ResultsAcross a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms.ConclusionIn our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.

Background: Telehealth has been proposed as one strategy to improve the quality of time‐sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth‐supplemented ED (tele‐ED) care, health care costs, and clinical outcomes among patients with sepsis in rural EDs. Methods: Cohort study using Medicare fee‐for‐service claims data for beneficiaries treated for sepsis in rural EDs between February 1, 2017, and September 30, 2019. Our primary hospital‐level analysis used multivariable generalized estimating equations to measure the association between treatment in a tele‐ED–capable hospital and 30‐day total costs of care. In our supporting secondary analysis, we conducted a propensity‐matched analysis of patients who used tele‐ED with matched controls from non–tele‐ED–capable hospitals. Our primary outcome was total health care payments among index hospitalized patients between the index ED visit and 30 days after hospital discharge, and our secondary outcomes included hospital mortality, hospital length of stay, 90‐day mortality, 28‐day hospital‐free days, and 30‐day inpatient readmissions. Results: In our primary analysis, sepsis patients in tele‐ED–capable hospitals had 6.7% higher (95% confidence interval [CI] 2.1%–11.5%) total health care costs compared to those in non–tele‐ED–capable hospitals. In our propensity‐matched patient‐level analysis, total health care costs were 23% higher (95% CI 16.5%–30.4%) in tele‐ED cases than matched non–tele‐ED controls. Clinical outcomes were similar. Conclusions: Tele‐ED capability in a mature rural tele‐ED network was not associated with decreased health care costs or improved clinical outcomes. Future work is needed to reduce rural–urban sepsis care disparities and formalize systems of regionalized care. [ABSTRACT FROM AUTHOR]

Background:Treatment crossovers occur when one mode of treatment is begun and then a different mode of treatment is utilized. Treatment crossovers are frequently examined in randomized controlled trials, but have been rarely noted or quantitatively evaluated in usual care treatment studies. The purpose of this analysis is to examine the extent of modality crossovers during behavioral health treatment. Methods:The nonrandomized, prospective, multisite research design involved two active treatment groups—a telehealth treatment cohort and an in-person treatment cohort. Treatment modality (telehealth or in person) during each encounter was compared overall and across two time periods (pre- and during the COVID-19 pandemic) between the telehealth cohort and the in-person cohort. Results:Overall, modality crossovers were relatively uncommon (6.3%). However, patients in the in-person treatment cohort were more than twice as likely to have an encounter through telehealth (8.5%) than patients in the telehealth treatment cohort were to have an in-person encounter (3.4%) even though they had the same average number of encounters. The occurrence of off-mode encounters was particularly influenced by the onset of the COVID-19 pandemic. Conclusions:In this multisite usual care study comparing telehealth and in-person behavioral health treatment, modality crossovers were more common in the in-person cohort than the telehealth cohort, especially during the COVID-19 pandemic. Because telehealth availability has increased, crossovers are likely to increase in patients receiving multiple encounters for behavioral or chronic conditions and their occurrence should be noted by both researchers and practitioners. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations of accountable care organization (ACO) characteristics with the likelihood of participation in 2‐sided risk tracks in the Medicare Shared Savings Program (SSP). Methods: CMS ACO Public Use Files and Provider‐Level Research Identifiable Files were used to trace Medicare ACOs' participation in the SSP between 2012 and 2020 and measure ACO characteristics, including size, rurality of the service area, affiliation with supporting organizations, program experience, and performance. Logistic regression and survival analysis were used to test the associations between ACO characteristics and the probability of ACOs initially participating in or subsequently switching to 2‐sided risk tracks. Findings: Among the 624 Medicare SSP ACOs that started between 2012 and 2017, 26 participated in 2‐sided risk tracks in their initial contracts and 95 switched to 2‐sided risk tracks subsequently. ACO characteristics were not significantly associated with the probability of participating in 2‐sided risk tracks in initial contracts. ACO size, affiliation with supporting organizations, and performance were positively associated with the likelihood of switching to 2‐sided risk. Rural ACOs were less likely to switch to 2‐sided risk than their urban counterparts. Conclusions: Small and rural ACOs are less prepared to transition into 2‐sided risk swiftly. [ABSTRACT FROM AUTHOR]