Exploring Rural Kansas Hospital Leaders’ Perceptions of Accountable Care Organizations

Introduction.Accountable Care Organizations (ACOs) have been shown to reduce healthcare costs while improving healthcare quality.However, their adoption rates are low in rural regions (populations <50K).Understanding the perceptions of rural Kansas hospital leadership on ACO participation is key to optimizing rural healthcare.This study evaluated perceived familiarity with ACOs, benefits/barriers, and key deciding factors of ACO participation in rural Kansas hospitals.Methods.Using a mixed-methods, cross-sectional survey distributed through Kansas Hospital Association (KHA) communications to rural hospital leadership, collected data included Likertlike scales for ACO familiarity, perceived barriers, and perceived advantages.Open-ended questions regarding the overall view of ACO participation were included.Data were analyzed with descriptive and thematic qualitative analysis. Results.The 24-question survey received 13 completed responses.Response rate is unknown due to convenience sampling through a third-party partner (KHA).Most respondents (12) held salaried leadership roles; 10 represented a critical access hospital.Twelve participants reported familiarity with ACOs, and five reported current participation.Perceptions were divided based on current ACO participation.ACO participants held a more favorable view, emphasizing the benefits of participation.Non-ACO participants emphasized perceived drawbacks and barriers, focusing on financial and logistical concerns.Financial concerns were the most frequently mentioned free response answer to what would determine participation status.Conclusions.Enhancing logistical support, in the form of staffing, EHR, and reducing regulatory burden, as well as financial support could improve ACO perception and subsequent participation in rural Kansas.Future research should increase sampling efforts and evaluate longitudinal outcomes of ACO participation in the rural Kansas scope.