We conducted cross-sectional and longitudinal analyses of Accountable Care Organization (ACO) quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 Medicare Shared Savings Program (MSSP) ACOs that had successfully reported quality measures in 2014 and 2015, respectively.

Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance.

There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate.