Association of Patient Outcomes With Bundled Payments Among Hospitalized Patients Attributed to Accountable Care Organizations

Abstract

IMPORTANCEIt is unknown how outcomes are affected when patients receive care under bundled payment and accountable care organization (ACO) programs simultaneously. OBJECTIVE To evaluate whether outcomes in the Medicare Bundled Payments for Care Improvement (BPCI) program differed depending on whether patients were attributed to ACOs in the Medicare Shared Savings Program. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using Medicare claims data from January 1, 2011, to September 30, 2016, and difference-in-differences analysis to compare episode outcomes for patients admitted to BPCI vs non-BPCI hospitals. Outcomes were stratified for patients who were and were not attributed to an ACO. Participants included Medicare fee-forservice beneficiaries receiving care for medical and surgical episodes at US hospitals. Data were analyzed between October 1, 2018, and June 10, 2021. EXPOSURES Hospitalization for any of the 48 episodes (24 medical, 24 surgical) included in the BPCI at US hospitals participating in the BPCI for those episodes. MAIN OUTCOMES AND MEASURES The primary outcome was change in 90-day postdischarge institutional spending, and secondary outcomes included changes in quality and utilization. RESULTS A total of 7 108 146 beneficiaries (mean [SD] age, 76.9 [12.2] years; 4 101 081 women [58%]) received care for medical episodes, and 3 675 962 beneficiaries (mean [SD] age, 74.8 [10.1] years; 2 074 921 women [56%]) received care for surgical episodes. Compared with patients whowere not attributed to ACOs, the association between bundled payments and changes in postdischarge institutional spending was larger among patients attributed to ACOs

Care Disruption During COVID-19: a National Survey of Hospital Leaders

“…Safety-net hospitals reported lower participation in value-based payment prior to COVID when compared to other hospitals. Although there was no significant difference between groups in decreasing or suspending these efforts during COVID, to the extent that participation in these payment models is associated with improvements in care and outcomes, 34 these differences are notable. Since many value-based and alternative payment models were suspended during the pandemic, the long-term impact on participation remains to be seen.…”

Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States

“…Geriatric hospitals, if modeled after successful geriatric models, should be able to do this better than typical adult hospitals. Also, health care systems that participate as an Accountable Care Organization with bundled payments may find geriatric hospitals beneficial since some of the cost savings with geriatric models of care can occur after discharge, for example related to increased likelihood of discharge home instead of a facility and reduced readmission rates ( Deschodt et al, 2013 ; Flood et al, 2013 ; Navathe et al, 2021 ; Palmer, 2018 ).…”

The Effect of Network-Level Payment Models on Care Network Performance: A Scoping Review of the Empirical Literature

“…All other measures of medical testing increased as was envisioned [47]. Furthermore, the use of institutional postdischarge facilities was successfully reduced [50]. The model negatively impacted performance on total spending, medical specialist and medication spending, but post discharge spending and primary care spending were curbed [46,47,49,50].…”

“…Furthermore, the use of institutional postdischarge facilities was successfully reduced [50]. The model negatively impacted performance on total spending, medical specialist and medication spending, but post discharge spending and primary care spending were curbed [46,47,49,50]. One qualitative study [48] mapped other consequences and found some positive effects (better collaboration, greater transparency, and better process quality) but also some negative ones (increased administrative burden, greater price variations, and unwanted dominance by GP care groups).…”

“…One qualitative study [48] mapped other consequences and found some positive effects (better collaboration, greater transparency, and better process quality) but also some negative ones (increased administrative burden, greater price variations, and unwanted dominance by GP care groups). Quality indicators were identified in one study, indicating no significant effect on mortality and a desired decrease in readmissions, with the exception that readmissions for medical episodes were not significantly affected if the bundled payment was not in the setting of an ACO [50].…”