Physician Group Practices Accrued Large Bonuses Under Medicare's Bundled Payment Model, 2018-20.

IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Health Affairs Pub Date : 2024-05-01 DOI:10.1377/hlthaff.2023.00915
Sukruth A Shashikumar, Zoey Chopra, Jason D Buxbaum, Karen E Joynt Maddox, Andrew M Ryan
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Abstract

The Bundled Payments for Care Improvement Advanced Model (BPCI-A), a voluntary Alternative Payment Model for Medicare, incentivizes hospitals and physician group practices to reduce spending for patient care episodes below preset target prices. The experience of physician groups in BPCI-A is not well understood. We found that physician groups earned $421 million in incentive payments during BPCI-A's first four performance periods (2018-20). Target prices were positively associated with bonuses, with a mean reconciliation payment of $139 per episode in the lowest decile of target prices and $2,775 in the highest decile. In the first year of the COVID-19 pandemic, mean bonuses increased from $815 per episode to $2,736 per episode. These findings suggest that further policy changes, such as improving target price accuracy and refining participation rules, will be important as the Centers for Medicare and Medicaid Services continues to expand BPCI-A and develop other bundled payment models.

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在 2018-20 年医疗保险捆绑支付模式下,医生团体诊所获得了巨额奖金。
医疗改善捆绑支付高级模式(BPCI-A)是医疗保险的一种自愿性替代支付模式,它激励医院和医生团体减少低于预设目标价格的患者护理事件支出。医生团体在 BPCI-A 中的经验尚不十分清楚。我们发现,在 BPCI-A 的前四个绩效期(2018-20 年),医生团体获得了 4.21 亿美元的奖励金。目标价格与奖金呈正相关,目标价格最低十分位数的每集平均调节付款为 139 美元,最高十分位数为 2775 美元。在 COVID-19 大流行的第一年,平均奖金从每集 815 美元增至每集 2736 美元。这些研究结果表明,随着医疗保险和医疗补助服务中心继续扩大 BPCI-A 并开发其他捆绑式支付模式,进一步的政策变化(如提高目标价格的准确性和完善参与规则)将非常重要。
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来源期刊
Health Affairs
Health Affairs 医学-卫生保健
CiteScore
15.00
自引率
2.10%
发文量
246
审稿时长
3-6 weeks
期刊介绍: Health Affairs is a prestigious journal that aims to thoroughly examine significant health policy matters both domestically and globally. Our publication is committed to addressing issues that are relevant to both the private and public sectors. We are enthusiastic about inviting private and public decision-makers to contribute their innovative ideas in a publishable format. Health Affairs seeks to incorporate various perspectives from industry, labor, government, and academia, ensuring that our readers benefit from the diverse viewpoints within the healthcare field.
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