Researchers at the The Dartmouth Institute for Health Policy and Clinical Practice have found that hospitals participating in Accountable Care Organizations tend to be large and urban.

Using data from the National Survey of Accountable Care Organizations and the Leavitt Partners ACO Database, the study, says a Dartmouth press release, “analyzed the types of hospitals participating in ACOs to determine whether they differed from those not participating. The study used interviews with key ACO personnel (predominantly chief medical officers) to examine the {characteristics} of hospital participation in ACOs.”

Among the findings:

• “20 percent of U.S. hospitals were part of ACO in 2014.”
• “Large hospitals rather than smaller ones were more likely to have an ACO contract. Hospitals participating in ACOs were most likely to be in the most heavily populated urban areas and least likely to be in more rural areas, with more than two-thirds  in the Eastern or Pacific  time zones.”
• “For hospitals that participated in ACOs, 13 percent of the population in the hospital’s catchment area had incomes under the federal poverty level, compared to 16 percent for hospitals not participating in an ACO.”
• “The large majority (85 percent of hospitals that participated in ACOs were short-term acute-care hospitals, rather than specialty or critical- access hospitals.”
• “Teaching hospitals and those that offered a greater number of services (such as obstetrics and intensive care) were more likely to participate in ACOs, compared to non-teaching hospitals and those that offered fewer services.”

The study found these advantages of being in an ACO:

• “Most representatives of ACOs with a hospital reported that the hospital was an advantageous source of capital to the ACO, while leaders of ACOs without hospitals thought a hospital would be a useful source of capital.”
• “Other strategic advantages of hospital participation in an ACO included patient data sharing between inpatient and outpatient settings, such as discharge summaries or alerts to an emergency admission, as well as the ability to align financial incentives across care settings to regulate costs and ensure quality.”

The study’s authors conclude, the press release said, that “policymakers have the ability to negate some of the perceived disadvantages of forming an ACO without a hospital by providing access to capital and support for implementing health information exchange systems. They also note that for ACOs to meet quality and cost goals it will be ‘important to ensure broader and more consistent participation of different types of providers in the model.”