Hospital Participation Decisions In Medicare Bundled Payment Program Were Influenced By Third-Party Conveners

Berlin, Nicholas L.; Peterson, Timothy A.; Chopra, Zoey; Gulseren, Baris; Ryan, Andrew M.

doi:10.1377/hlthaff.2020.01766

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Third, we are unable to measure changes in other costs and overhead that hospitals may have experienced in preparation for participation in BPCI-A. 47 Fourth, we captured clinical outcomes using claims data, which are somewhat blunt, as they do not contain the granularity that could provide a more accurate picture of patient-specific clinical characteristics and illness severity. Fifth, we were able to evaluate only the first year of BPCI-A.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement – Advanced

Shashikumar,

Zheng,

Orav

et al. 2023

Circulation

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BACKGROUND: Bundled Payments for Care Improvement Advanced (BPCI-A) is a Medicare initiative that aims to incentivize reductions in spending for episodes of care that start with a hospitalization and end 90 days after discharge. Cardiovascular disease, an important driver of Medicare spending, is one of the areas of focus BPCI-A. It is unknown whether BPCI-A is associated with spending reductions or quality improvements for the 3 cardiovascular medical events or 5 cardiovascular procedures in the model. METHODS: In this retrospective cohort study, we conducted difference-in-differences analyses using Medicare claims for patients discharged between January 1, 2017, and September 30, 2019, to assess differences between BPCI-A hospitals and matched nonparticipating control hospitals. Our primary outcomes were the differential changes in spending, before versus after implementation of BPCI-A, for cardiac medical and procedural conditions at BPCI-A hospitals compared with controls. Secondary outcomes included changes in patient complexity, care use, healthy days at home, readmissions, and mortality. RESULTS: Baseline spending for cardiac medical episodes at BPCI-A hospitals was $25 606. The differential change in spending for cardiac medical episodes at BPCI-A versus control hospitals was $16 (95% CI, −$228 to $261; P =0.90). Baseline spending for cardiac procedural episodes at BPCI-A hospitals was $37 961. The differential change in spending for cardiac procedural episodes was $171 (95% CI, −$429 to $772; P =0.58). There were minimal differential changes in physicians’ care patterns such as the complexity of treated patients or in their care use. At BPCI-A versus control hospitals, there were no significant differential changes in rates of 90-day readmissions (differential change, 0.27% [95% CI, −0.25% to 0.80%] for medical episodes; differential change, 0.31% [95% CI, −0.98% to 1.60%] for procedural episodes) or mortality (differential change, −0.14% [95% CI, −0.50% to 0.23%] for medical episodes; differential change, −0.36% [95% CI, −1.25% to 0.54%] for procedural episodes). CONCLUSIONS: Participation in BPCI-A was not associated with spending reductions, changes in care use, or quality improvements for the cardiovascular medical events or procedures offered in the model.

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Section: Discussionmentioning

confidence: 99%

Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement – Advanced

Shashikumar,

Zheng,

Orav

et al. 2023

Circulation

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“…We excluded episodes among patients who were eligible for Medicare on the basis of end-stage renal disease, whose primary payer was not Medicare, who had any of several exclusion diagnoses, or who died during the index admission (eTable 2 in the Supplement). We standardized spending to account for differences in Medicare payments across regions and types of hospitals . Per CMS methodology, we winsorized spending at the 1st and 99th percentiles of all episode payments.…”

Section: Methodsmentioning

confidence: 99%

Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments

Shashikumar

Gulseren

Berlin

et al. 2022

JAMA

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ImportanceBundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare &amp; Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS.ObjectiveTo investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties.Design, Setting, and ParticipantsDifference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics.ExposuresBPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019).Main Outcomes and MeasuresHospitals’ per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital.ResultsThe study identified 694 participating hospitals. The analysis observed a −$175 change in mean per-episode spending (95% CI, −$378 to $28) and an aggregate spending change of −$75.1 million (95% CI, −$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups.Conclusions and RelevanceAmong US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.

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“…One of the largest voluntary payment models run by the Center for Medicare & Medicaid Innovation (CMMI) is the Bundled Payments for Care Improvement (BPCI) Initiative . Prior studies have focused primarily on early adopter hospitals and did not consider the role of dropout history and indirect exposure through physicians . This study examines whether prior participation in the BPCI Initiative, direct or indirect through physician group practices (PGPs), was associated with their participation in the next generation of the program (BPCI Advanced).…”

Section: Introductionmentioning

confidence: 99%

Hospital and Physician Group Practice Participation in Prior and Next-Generation Value-Based Payment Programs

Kang,

Anderson

2024

JAMA Netw Open

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Hospital Participation Decisions In Medicare Bundled Payment Program Were Influenced By Third-Party Conveners

Cited by 4 publications

References 13 publications

Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement – Advanced

Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement – Advanced

Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments

Hospital and Physician Group Practice Participation in Prior and Next-Generation Value-Based Payment Programs

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