Zoey Chopra1, Baris Gulseren, Karan R Chhabra, Justin B Dimick, Andrew M Ryan. 1. *Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI †Department of Economics, University of Michigan, Ann Arbor, MI ‡School of Public Health, University of Michigan, Ann Arbor, MI §National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI ||Department of Surgery, Brigham and Women's Hospital, Boston, MA ¶Department of Surgery, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To evaluate associations between hospital participation in Bundled Payments for Care Improvement (BPCI) and thirty-day total episode and post-acute care spending for lower extremity joint replacement (LEJR), coronary artery bypass graft (CABG), and colectomy. SUMMARY BACKGROUND DATA: BPCI has been shown to reduce spending for LEJR episodes only, largely from reductions in post-acute care. However, BPCI efficacy in other common elective procedures, including CABG and colectomy, remains unclear. It is also unknown whether post-acute care spending reductions drive total spending reductions outside of LEJR. METHODS: Retrospective cohort study using 100% Medicare claims data to identify BPCI (312 total) and non-BPCI (1,977 total) acute care hospitals from January 1, 2010 to November 30, 2016 with Medicare-enrolled patient discharges for at least one BPCI episode: LEJR (454,369 episodes), CABG (107,307 episodes), or colectomy (73,717 episodes). Along with difference-in-differences analysis, we constructed generalized synthetic controls in the presence of non-parallel trends to estimate associations between BPCI participation and thirty-day total and post-acute care spending. RESULTS: Difference-in-differences estimates indicated reduced spending for LEJR (-$541.6 (95% CI: -718.0 to -365.3)) and colectomy (-$582.1 (95% CI: -927.3 to -236.8)) but not CABG (-$268.9 (95% CI: -831.5 to 293.7)). Generalized synthetic control estimates indicated reduced spending for LEJR (-$795.3 (95% CI: -1022.1 to -582.2)) but not colectomy (-$251.3 (95% CI: -997.9 to 335.2)) or CABG (-$257.8 (95% CI: -1024.6 to 414.8)). Post-acute care comprised 42.6% of LEJR spending reductions and 53.0% of colectomy spending reductions. CONCLUSIONS: BPCI participation was associated with significant spending reductions for LEJR and colectomy but not CABG. We conclude that BPCI has episode-dependent efficacy, largely determined by post-acute care.
OBJECTIVE: To evaluate associations between hospital participation in Bundled Payments for Care Improvement (BPCI) and thirty-day total episode and post-acute care spending for lower extremity joint replacement (LEJR), coronary artery bypass graft (CABG), and colectomy. SUMMARY BACKGROUND DATA: BPCI has been shown to reduce spending for LEJR episodes only, largely from reductions in post-acute care. However, BPCI efficacy in other common elective procedures, including CABG and colectomy, remains unclear. It is also unknown whether post-acute care spending reductions drive total spending reductions outside of LEJR. METHODS: Retrospective cohort study using 100% Medicare claims data to identify BPCI (312 total) and non-BPCI (1,977 total) acute care hospitals from January 1, 2010 to November 30, 2016 with Medicare-enrolled patient discharges for at least one BPCI episode: LEJR (454,369 episodes), CABG (107,307 episodes), or colectomy (73,717 episodes). Along with difference-in-differences analysis, we constructed generalized synthetic controls in the presence of non-parallel trends to estimate associations between BPCI participation and thirty-day total and post-acute care spending. RESULTS: Difference-in-differences estimates indicated reduced spending for LEJR (-$541.6 (95% CI: -718.0 to -365.3)) and colectomy (-$582.1 (95% CI: -927.3 to -236.8)) but not CABG (-$268.9 (95% CI: -831.5 to 293.7)). Generalized synthetic control estimates indicated reduced spending for LEJR (-$795.3 (95% CI: -1022.1 to -582.2)) but not colectomy (-$251.3 (95% CI: -997.9 to 335.2)) or CABG (-$257.8 (95% CI: -1024.6 to 414.8)). Post-acute care comprised 42.6% of LEJR spending reductions and 53.0% of colectomy spending reductions. CONCLUSIONS: BPCI participation was associated with significant spending reductions for LEJR and colectomy but not CABG. We conclude that BPCI has episode-dependent efficacy, largely determined by post-acute care.
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