Karen E Joynt Maddox1, E John Orav1, Jie Zheng1, Arnold M Epstein1. 1. From Washington University School of Medicine, St. Louis (K.E.J.M.); and Brigham and Women's Hospital (E.J.O., A.M.E.) and Harvard T.H. Chan School of Public Health (E.J.O., J.Z., A.M.E.) - both in Boston.
Abstract
BACKGROUND: The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. A subsequent study showed that the initiative was associated with reductions in Medicare payments for total joint replacement, but little is known about the effect of BPCI on medical conditions. METHODS: We used Medicare claims from 2013 through 2015 to identify admissions for the five most commonly selected medical conditions in BPCI: congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction (AMI). We used difference-in-differences analyses to assess changes in standardized Medicare payments per episode of care (defined as the hospitalization plus 90 days after discharge) for these conditions at BPCI hospitals and matched control hospitals. RESULTS: A total of 125 hospitals participated in BPCI for CHF, 105 hospitals for pneumonia, 101 hospitals for COPD, 88 hospitals for sepsis, and 73 hospitals for AMI. At baseline, the average Medicare payment per episode of care across the five conditions at BPCI hospitals was $24,280, which decreased to $23,993 during the intervention period (difference, -$286; P=0.41). Control hospitals had an average payment for all episodes of $23,901, which decreased to $23,503 during the intervention period (difference, -$398; P=0.08; difference in differences, $112; P=0.79). Changes from baseline to the intervention period in clinical complexity, length of stay, emergency department use or readmission within 30 or 90 days after hospital discharge, or death within 30 or 90 days after admission did not differ significantly between the intervention and control hospitals. CONCLUSIONS: Hospital participation in five common medical bundles under BPCI was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality. (Funded by the Commonwealth Fund.).
BACKGROUND: The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. A subsequent study showed that the initiative was associated with reductions in Medicare payments for total joint replacement, but little is known about the effect of BPCI on medical conditions. METHODS: We used Medicare claims from 2013 through 2015 to identify admissions for the five most commonly selected medical conditions in BPCI: congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction (AMI). We used difference-in-differences analyses to assess changes in standardized Medicare payments per episode of care (defined as the hospitalization plus 90 days after discharge) for these conditions at BPCI hospitals and matched control hospitals. RESULTS: A total of 125 hospitals participated in BPCI for CHF, 105 hospitals for pneumonia, 101 hospitals for COPD, 88 hospitals for sepsis, and 73 hospitals for AMI. At baseline, the average Medicare payment per episode of care across the five conditions at BPCI hospitals was $24,280, which decreased to $23,993 during the intervention period (difference, -$286; P=0.41). Control hospitals had an average payment for all episodes of $23,901, which decreased to $23,503 during the intervention period (difference, -$398; P=0.08; difference in differences, $112; P=0.79). Changes from baseline to the intervention period in clinical complexity, length of stay, emergency department use or readmission within 30 or 90 days after hospital discharge, or death within 30 or 90 days after admission did not differ significantly between the intervention and control hospitals. CONCLUSIONS: Hospital participation in five common medical bundles under BPCI was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality. (Funded by the Commonwealth Fund.).
Authors: Ana M Progovac; Brian O Mullin; Timothy B Creedon; Alex McDowell; Maria Jose Sanchez-Roman; Laura A Hatfield; Mark A Schuster; Benjamin Lê Cook Journal: LGBT Health Date: 2019-08-22 Impact factor: 4.151
Authors: Joseph Kannry; Jeff Smith; Vishnu Mohan; Bruce Levy; John Finnell; Christoph U Lehmann Journal: Appl Clin Inform Date: 2020-10-28 Impact factor: 2.342
Authors: Julius L Chen; Michael E Chernew; A Mark Fendrick; Joseph W Thompson; Sherri Rose Journal: J Gen Intern Med Date: 2019-09-16 Impact factor: 5.128
Authors: Ali Jalali; Christopher Martin; Richard E Nelson; Megan E Vanneman; Brook I Martin; Kathleen A Cooney; Norman J Waitzman; Brock O'Neil Journal: Med Care Date: 2020-02 Impact factor: 2.983
Authors: Matt Toth; Paul Moore; Elizabeth Tant; Regina Rutledge; Heather Beil; Sam Arbes; Nathan West; Suzanne L West Journal: Health Serv Res Date: 2020-05-21 Impact factor: 3.402