Matthew C. Baker, Erin N. Hahn, Theresa R.F. Dreyer, Keith A. Horvath
{"title":"医疗保险最新捆绑支付计划的成功:教学医院的结果","authors":"Matthew C. Baker, Erin N. Hahn, Theresa R.F. Dreyer, Keith A. Horvath","doi":"10.1016/j.hjdsi.2022.100672","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>In 2018, Medicare implemented a successor to its Bundled Payments for Care Improvement (BPCI) program, BPCI Advanced, with stricter participation rules and new financial incentives to reduce spending.</p></div><div><h3>Methods</h3><p>Using claims-based episode data from thirteen participants, we compared spending and utilization in the first fifteen months of the new program (October 2018 to December 2019) to hospital- and episode-specific target prices, with a deep dive into clinical correlates for the most commonly-selected clinical episodes, sepsis and congestive heart failure.</p></div><div><h3>Results</h3><p>Twelve out of thirteen participants in a collaborative of teaching hospitals achieved shared savings for both Medicare and their own institution. Aggregate hospital shared savings were 5.8% of benchmark prices across 6,131 patients in 16 clinical episodes (p<0.001), appreciably higher than the reference savings rates reported after the first period of Medicare’s predecessor BPCI program. Differences in shared savings across hospitals for sepsis and congestive heart failure correlated with reductions in patients’ use of post-acute care, including reductions in skilled nursing facility, readmission, and home health rates. Evidence is presented showing reductions in patient utilization for cost-intensive post-acute settings accompanied increases in the proportion of patients exclusively utilizing non-institutional care after discharge from an anchor stay or procedure.</p></div><div><h3>Conclusions</h3><p>These findings provide an example of the fulfillment of a core promise of bundled payments to uncover new opportunities for reduced spending.</p></div><div><h3>Level of evidence</h3><p>Non-random cohort of hospitals.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"11 1","pages":"Article 100672"},"PeriodicalIF":2.0000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Succeeding in Medicare’s newest bundled payment program: Results from teaching hospitals\",\"authors\":\"Matthew C. Baker, Erin N. Hahn, Theresa R.F. Dreyer, Keith A. Horvath\",\"doi\":\"10.1016/j.hjdsi.2022.100672\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>In 2018, Medicare implemented a successor to its Bundled Payments for Care Improvement (BPCI) program, BPCI Advanced, with stricter participation rules and new financial incentives to reduce spending.</p></div><div><h3>Methods</h3><p>Using claims-based episode data from thirteen participants, we compared spending and utilization in the first fifteen months of the new program (October 2018 to December 2019) to hospital- and episode-specific target prices, with a deep dive into clinical correlates for the most commonly-selected clinical episodes, sepsis and congestive heart failure.</p></div><div><h3>Results</h3><p>Twelve out of thirteen participants in a collaborative of teaching hospitals achieved shared savings for both Medicare and their own institution. Aggregate hospital shared savings were 5.8% of benchmark prices across 6,131 patients in 16 clinical episodes (p<0.001), appreciably higher than the reference savings rates reported after the first period of Medicare’s predecessor BPCI program. Differences in shared savings across hospitals for sepsis and congestive heart failure correlated with reductions in patients’ use of post-acute care, including reductions in skilled nursing facility, readmission, and home health rates. 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Succeeding in Medicare’s newest bundled payment program: Results from teaching hospitals
Background
In 2018, Medicare implemented a successor to its Bundled Payments for Care Improvement (BPCI) program, BPCI Advanced, with stricter participation rules and new financial incentives to reduce spending.
Methods
Using claims-based episode data from thirteen participants, we compared spending and utilization in the first fifteen months of the new program (October 2018 to December 2019) to hospital- and episode-specific target prices, with a deep dive into clinical correlates for the most commonly-selected clinical episodes, sepsis and congestive heart failure.
Results
Twelve out of thirteen participants in a collaborative of teaching hospitals achieved shared savings for both Medicare and their own institution. Aggregate hospital shared savings were 5.8% of benchmark prices across 6,131 patients in 16 clinical episodes (p<0.001), appreciably higher than the reference savings rates reported after the first period of Medicare’s predecessor BPCI program. Differences in shared savings across hospitals for sepsis and congestive heart failure correlated with reductions in patients’ use of post-acute care, including reductions in skilled nursing facility, readmission, and home health rates. Evidence is presented showing reductions in patient utilization for cost-intensive post-acute settings accompanied increases in the proportion of patients exclusively utilizing non-institutional care after discharge from an anchor stay or procedure.
Conclusions
These findings provide an example of the fulfillment of a core promise of bundled payments to uncover new opportunities for reduced spending.
期刊介绍:
HealthCare: The Journal of Delivery Science and Innovation is a quarterly journal. The journal promotes cutting edge research on innovation in healthcare delivery, including improvements in systems, processes, management, and applied information technology.
The journal welcomes submissions of original research articles, case studies capturing "policy to practice" or "implementation of best practices", commentaries, and critical reviews of relevant novel programs and products. The scope of the journal includes topics directly related to delivering healthcare, such as:
● Care redesign
● Applied health IT
● Payment innovation
● Managerial innovation
● Quality improvement (QI) research
● New training and education models
● Comparative delivery innovation