BPCI Participation Not Linked With Significant Changes in Payments or Readmission

Previous research revealed the Bundled Payments for Care Improvement (BPCI) initiative, launched by the Center for Medicare and Medicaid Innovation (CMMI) in 2013, was associated with reductions in Medicare payments for total joint replacement; however, a new study found hospital participation in 5 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.

The study, published in the New England Journal of Medicine, collected data from Medicare claims from 2013 through 2015 in order to identify admissions for the most commonly selected medical conditions in BPCI, including congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction (AMI).

The researchers then evaluated the changes in standardized Medicare payments per episode of care (hospitalization and 90 days after discharge) for each condition at BPCI hospitals and compared the data to matched control hospitals.

“BPCI is a voluntary program, and hospitals that choose to participate may select from several models,” the authors explained. "Under model 2, the most popular model among hospitals, participating hospitals assume accountability for the costs of all care within 30, 60, or 90 days after hospitalization for 1 or more of 48 conditions that together account for approximately 70% of Medicare spending. Hospitals may choose the conditions and the time window. If cost targets are achieved, participating hospitals keep a portion of the savings; if cost targets are exceeded, participating hospitals reimburse Medicare for part of the difference.”

There was a total of 125 hospitals for CHF that participated in BPCI, 105 for pneumonia, 101 for COPD, 88 for sepsis, and 73 hospitals for AMI. At baseline, the researchers found the average Medicare payment per episode of care among the 5 conditions was $24,280 and decreased to $23,993 during the intervention period. Control hospitals, at baseline, had an average payment for all episodes of $23,901 and this decreased to $23,503 during the intervention period.

The study noted that changes in clinical complexity, length of stay, emergency department use, or readmission within 30 or 90 days after discharge, or death within 30 or 90 days after admission did not differ significantly between the intervention and control hospitals.

“Bundling of services to encourage more efficient care has great face validity and enjoys bipartisan support,” the authors concluded. “For such bundling to work for medical conditions, however, more time, new care strategies and partnerships, or additional incentives may be required.”

Reference

Joynt Maddox KE, Orav EJ, Zheng J, Epstein AM. Evaluation of Medicare's Bundled Payments Initiative for medical conditions. N Engl J Med. 2018; 379(3):260-269. doi: 10.1056/NEJMsa1801569.