Are Accountable Care Organizations Beneficial for Anesthesia Services? Preliminary Results from the National ACO Longitudinal Study

By February 14, 2019 No Comments

As silos begin to disintegrate throughout healthcare in the United States, Accountable Care Organizations are often referenced as an exciting model for how to effectively bring stakeholders together in order to provide the greatest care for the greatest number of patients.

To review, Accountable Care Organizations, or ACOs, are a healthcare collaboration in which payers and providers align to treat a specific patient population (1). ACOs could include value-based care initiatives, such as encouraging population health through incentive programs, as well as the implementation of innovative cost savings programs. Throughout it all, ACOs aim to coordinate care across the designated patient population. Although the initial ACOs were emphasized for primary care, more recently ACOs have expanded to include surgical and anesthesia providers in order to include tertiary and specialty care for patients. In effect, anesthesiologists and anesthesia providers may participate in an ACO by means of their current hospital or employer, or they may also spearhead anesthesia specific mechanisms through what is known as Accountable Anesthesia Organizations, or AAOs. As the name suggests, AAOs are anesthesia-specific ACO collaborations, led and managed by leaders in the anesthesia services field.


As ACOs have been enveloped in the U.S. healthcare system for several years, it is now useful for healthcare leaders to analyze ACO progress thus far, along with areas for improvement moving forward. With this objective in mind, a research team from the University of Michigan’s Center for Healthcare Outcomes and Policy underwent a longitudinal study that analyzed a decade’s worth of data at the national level (2). The aim of the study was to examine hospital and healthcare centers that are engaged participants in ACOs and elucidate whether these centers experienced a decline in surgical spending as a result of their ACO affiliation. As surgical spending represents a significant portion of hospital global budgets, the metric was selected as a proxy for evaluating the broader ACO evolution. During the study, variables such as hospital-specific patient segmentation, number of anesthesia and surgical staff, and other specificities were treated to control for potential confound.

By the study’s completion, the research team concluded that participation in ACOs was not associated with a decrease in surgical spending. This effect was consistent among expenditures related to staffing, e.g. for anesthesia and surgical providers, post-acute care providers, and so forth, as well as global surgical costs for patient length of stays and medications management. In an additional result, the researchers found that patient outcomes improved at ACO hospitals compared to the control, although this effect was not strongly statistically significant. The study’s results have several applications for future practice. Leadership should be cognizant that ACOs, or AAOs in the case of anesthesia providers, may not reduce costs in the initialization stage of coordinated care. However, notably an improvement in patient outcomes could result in viable savings later down the line, reflecting a benefit for the hospital as well as access for patients.

Future healthcare delivery innovations will continue to promote partnerships among healthcare stakeholders. Anesthesiologists and additional anesthesia providers, as healthcare practitioners engaged in multiple stages of perioperative care, will effectively serve as connectors in this initiative to execute the highest level of care possible for every patient, before, during, and after surgery.