title: Cost savings associated with transfer of trauma patients within an accountable care organization.
abstract: BACKGROUND
  The Patient Protection and Affordable Care Act supports the establishment of accountable care organizations (ACOs) as care delivery models designed to save costs. The potential for these cost savings has been demonstrated in the primary care and inpatient populations, but not for patients with emergency conditions or traumatic injuries.
  
  
  METHODS
  Our study evaluated adult trauma patients transferred to the tertiary care hospitals of a pioneer ACO, comparing those who were transferred from within the ACO to those from outside the ACO in terms of overall cost of hospitalization. Hospital length of stay and number of imaging studies were predetermined secondary outcomes.
  
  
  RESULTS
  The study population included 7696 hospitalizations for traumatic injuries over a 5-year period, 85.1% of which were for patients transferred from outside the ACO. Patients transferred from within the ACO had a 7.2% lower overall cost of hospitalization (P = .032). Mean injury severity scores were not significantly different between groups. Differences in mortality, intensive care unit length of stay, and overall hospital length of stay were not significant. However, analysis of radiology studies performed during the hospitalization revealed that patients transferred from within the ACO had, on average, 0.47 fewer advanced imaging studies per hospitalization than did those transferred from outside the ACO (3.55 vs 4.02 studies per hospitalization, P = .003).
  
  
  CONCLUSIONS
  Adult trauma patients transferred from within an ACO have significantly lower total costs of hospitalization than do those transferred from outside the system, without significant differences in disease burden, hospital length of stay, or mortality.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: briancgeyer@gmail.com.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Geyer
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: dpeak@mgh.harvard.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Peak
authors.affiliation: Harvard Medical School, Boston, MA; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: gvelmahos@mgh.harvard.edu.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Harvard Medical School, Boston, MA; Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: jgates@partners.org.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gates
authors.affiliation: Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: ymichaud@partners.org.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Michaud
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: lpetrovick@partners.org.
authors.forename: Laurie
authors.initials: L
authors.lastname: Petrovick
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: Lee.Jarone@mgh.harvard.edu.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: byun@partners.org.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Yun
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: bwhite3@partners.org.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: White
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: asraja@partners.org.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics*; D017046:Cost Savings; D003952:Diagnostic Imaging / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics*; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics*; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*