医疗保险最新捆绑支付计划的成功:教学医院的结果

IF 2 4区 医学 Q3 HEALTH POLICY & SERVICES Healthcare-The Journal of Delivery Science and Innovation Pub Date : 2023-03-01 DOI:10.1016/j.hjdsi.2022.100672
Matthew C. Baker, Erin N. Hahn, Theresa R.F. Dreyer, Keith A. Horvath
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引用次数: 0

摘要

背景2018年,联邦医疗保险实施了其捆绑支付护理改善(BPCI)计划的后续计划BPCI Advanced,该计划有更严格的参与规则和新的财政激励措施来减少支出。方法使用来自13名参与者的基于索赔的发作数据,我们将新计划前15个月(2018年10月至2019年12月)的支出和使用情况与医院和发作的具体目标价格进行了比较,并深入研究了最常见的临床发作、败血症和充血性心力衰竭的临床相关性。结果在一个教学医院合作项目中,13名参与者中有12人实现了医疗保险和自己机构的共同储蓄。在16次临床发作中,6131名患者的医院共享储蓄总额为基准价格的5.8%(p<0.001),明显高于医疗保险前身BPCI计划第一期后报告的参考储蓄率。不同医院在败血症和充血性心力衰竭方面的共同储蓄差异与患者使用急性后护理的减少相关,包括熟练护理设施、再次入院和家庭健康率的减少。有证据表明,在费用密集型急性后环境中,患者利用率降低,同时在出院后专门利用非机构护理的患者比例增加。结论这些发现为实现捆绑支付的核心承诺提供了一个例子,以发现减少支出的新机会。证据水平医院的非随机队列。
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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.

Level of evidence

Non-random cohort of hospitals.

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来源期刊
CiteScore
4.90
自引率
0.00%
发文量
37
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
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