Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs

Navathe, Amol S.; Liao, Joshua M.; Polsky, Daniel; Shah, Yash; Huang, Qian; Zhu, Jingsan; Lyon, Zoe; Wang, Robin; Rolnick, Josh; Martinez, Joseph; Emanuel, Ezekiel J.

doi:10.1377/hlthaff.2017.1358

Cited by 30 publications

(17 citation statements)

References 17 publications

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“…Though bundled payment evaluations have predominantly emphasized procedural episodes, existing evidence suggests that participation in medical condition bundles has not been associated with cost savings or utilization changes. [7][8][9][10][11][12][13][14][15] Findings from our analysis of variance-that there appear to be smaller variation-reduction opportunities for condition episodes than for procedural episodes-offer insight into this issue. Existing episodes are initiated by hospitalization and extend into the postacute period, a design that may not afford substantial post-acute care savings opportunities for condition episodes.…”

Section: Discussionmentioning

confidence: 90%

Nationwide Hospital Performance on Publicly Reported Episode Spending Measures

Liao

Zhou

Navathe

2020

Journal of Hospital Medicine

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BACKGROUND: Medicare has implemented strategies to improve value by containing hospital spending for episodes of care. Compared with payment models, publicly reported episode-based spending measures are underrecognized strategies. OBJECTIVE: To provide the first nationwide description of hospitals’ episode-based spending based on publicly reported Clinical Episode-Based Payment (CEBP) measures. DESIGN, SETTING, AND PARTICIPANTS: We used 2017 Hospital Compare data to assess spending on six CEBPs among 1,778 hospitals. We examined spending variation and its drivers, correlation between CEBPs, and spending by cost performance categories (for individual CEBPs, below vs above average spending; for across-CEBP comparisons, high vs low vs mixed cost). We also compared hospital spending performance on CEBPs with a global Medicare Spending Per Beneficiary measure. MAIN OUTCOMES AND MEASURES: Episode spending. RESULTS: Episode spending varied by CEBP type, with skilled nursing facility (SNF) care accounting for the majority of spending variation for procedural episodes but not for condition episodes. Across CEBPs, greater proportions of episode spending were attributed to SNF care at high- (18.1%) vs mixed- (10.7%) vs low-cost (9.2%) hospitals (P > .001). There was low within-hospital CEBP correlation and low correlation and concordance between hospitals’ CEBP and Medicare Spending Per Beneficiary performance. CONCLUSIONS: Variation reduction and savings opportunities in SNF care for procedural episodes suggest that they may be better suited for existing payment models than condition episodes are. Spending performance was not hospital specific, which highlights the potential utility of episode spending measures beyond global measures.

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Section: Discussionmentioning

confidence: 90%

Nationwide Hospital Performance on Publicly Reported Episode Spending Measures

Liao

Zhou

Navathe

2020

Journal of Hospital Medicine

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“…[5][6][7][8] A study of the Baptist Health System, for example, a participant in the Acute Care Episode demonstration and BPCI initiative, found a 20.8% decline in Medicare payments through lower postacute spending. 21 Hospitals participating in the BPCI have been generally larger and had higher case volumes than CJR hospitals, 22 although hospitals achieving savings across both programs had higher case volumes than hospitals without savings. 23 The absence of changes in the volume of episodes or patient characteristics at the MSA level suggests that hospitals in the CJR, on average, generally did not perform operations on more patients or change their patient case mix in response to the program, similar to recent findings from the BPCI initiative.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements

Haas¹,

Zhang²,

Kaplan³

et al. 2019

JAMA Intern Med

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IMPORTANCE In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. OBJECTIVE To evaluate changes in key economic and clinical outcomes associated with the CJR model. DESIGN, SETTING, AND PARTICIPANTS A retrospective, national, population-based analysis of Medicare fee-for-service beneficiaries undergoing lower extremity joint replacement was conducted using 100% Medicare Part A data and 5% Medicare Part B data. Within an intention-to-treat framework, a difference-indifferences approach was used to compare Medicare spending, quality of care, volume of episodes, and patient selection in episodes of lower extremity joint replacements in the first 2 years of the program between propensity score-matched CJR and non-CJR hospitals (episodes initiated from April 1, 2016, through December 31, 2017, with the latter completed by March 31, 2018). Lower extremity joint replacement episodes in MSAs randomly assigned to the CJR model were compared with those in MSAs not assigned to the CJR model. EXPOSURES Random assignment of MSAs into the CJR model within prespecified strata. MAIN OUTCOMES AND MEASURES Spending and its components, quality of care, volume of episodes, and patient characteristics were the main outcomes. RESULTS After propensity score matching, there were 157 828 primary lower extremity joint replacement cases across 684 hospitals in the CJR (treatment) group (101 641 [64.4%] women; mean [SD] age, 72.8 [8.9] years) and 180 594 cases across 726 hospitals in the non-CJR (control) group (115 580 women [64.

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“…All outcomes were prespecified except discharge to skilled nursing, discharge to home health services, and total number of days receiving skilled nursing care, which were added retrospectively to help explain the observed spending shifts. All payments were standardized and adjusted to 2016 dollars 3435…”

Section: Methodsmentioning

confidence: 99%

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Rolnick

Liao

Emanuel

et al. 2020

BMJ

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ObjectiveTo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DesignQuasi-experimental difference-in-differences analysis.SettingUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.Participants238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.Main outcome measuresPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.ResultsIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change −0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (−1.2%, 95% confidence interval −2.3% to −0.2%). Spending on care at skilled nursing facilities decreased (−6.3%, −10.0% to −2.5%) owing to a reduced number of facility days (−6.2%, −9.8% to −2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (−0.1 percentage points, 95% confidence interval −0.5 to 0.2 percentage points).ConclusionsIn this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.

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Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs

Cited by 30 publications

References 17 publications

Nationwide Hospital Performance on Publicly Reported Episode Spending Measures

Nationwide Hospital Performance on Publicly Reported Episode Spending Measures

Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

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