title: Financial Performance of Rural Medicare ACOs.
abstract: The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence.
  
  
  
  We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan.
  
  
  
  Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance.
  
  
  
  Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted.
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, Iowa.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Nattinger
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, Iowa.
authors.forename: Keith
authors.initials: K
authors.lastname: Mueller
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, Iowa.
authors.forename: Fred
authors.initials: F
authors.lastname: Ullrich
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, Iowa.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhu
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D003430:Cross-Sectional Studies; D005376:Financial Management / Q000379:methods* / Q000592:standards; D006801:Humans; D006278:Medicare / Q000458:organization & administration / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000191:economics* / Q000592:standards; D014481:United States
keywords: Medicare; financial performance; health services research; policy; rural accountable care organizations