Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses

Ryan, Andrew M.; Shashikumar, Sukruth A; Chopra, Zoey; Maddox, Karen E. Joynt; Buxbaum, Jason

doi:10.1001/jama.2023.1435

Cited by 3 publications

(2 citation statements)

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“…On the other hand, BPCI-A is expected to cost CMS billions of dollars. 24 , 25 Despite this investment, we did not observe beneficial changes in the form of spending reductions or quality improvements for an important set of bundles offered.…”

Section: Discussionmentioning

confidence: 66%

“…BPCI-A is an expensive program that is expected to cost CMS more than $2 billion to administer after accounting for the payout of financial bonuses. 24,25 Therefore, understanding the association of BPCI-A with changes in spending, utilization, and outcomes for cardiovascular care has clinical and policy ramifications as CMS increasingly invests in alternative payment models. In undertaking our evaluation, we had 3 aims focused on the first year of BPCI-A (October 1, 2018-September 30, 2019): (1) to describe the characteristics of patients initiating cardiovascular episodes in BPCI-A; (2) to explore whether medically or socially complex patients were selectively precluded from initiating these episodes; and (3) to evaluate changes in spending, care utilization, and clinical outcomes for cardiovascular bundles.…”

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confidence: 99%

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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: 66%

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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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Association of bundled payments with spending, utilization, and quality for surgical conditions: A scoping review

Hider,

Gomez-Rexrode,

Agius

et al. 2024

The American Journal of Surgery

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Physician Group Practices Accrued Large Bonuses Under Medicare’s Bundled Payment Model, 2018–20

Shashikumar,

Chopra,

Buxbaum

et al. 2024

Health Affairs

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Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses

Abstract: This study examines the magnitude of reconciliation payments and clinical spending reductions necessary for the Centers for Medicare &amp; Medicaid Services to break even in the first 4 performance periods of the BPCI-A (Bundled Payments for Care Improvement Advanced) program.

Cited by 3 publications

References 4 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 bundled payments with spending, utilization, and quality for surgical conditions: A scoping review

Physician Group Practices Accrued Large Bonuses Under Medicare’s Bundled Payment Model, 2018–20

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Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses

Abstract: This study examines the magnitude of reconciliation payments and clinical spending reductions necessary for the Centers for Medicare &amp;amp; Medicaid Services to break even in the first 4 performance periods of the BPCI-A (Bundled Payments for Care Improvement Advanced) program.

Cited by 3 publications

References 4 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 bundled payments with spending, utilization, and quality for surgical conditions: A scoping review

Physician Group Practices Accrued Large Bonuses Under Medicare’s Bundled Payment Model, 2018–20

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Product

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Abstract: This study examines the magnitude of reconciliation payments and clinical spending reductions necessary for the Centers for Medicare & Medicaid Services to break even in the first 4 performance periods of the BPCI-A (Bundled Payments for Care Improvement Advanced) program.