CMS bundled payment program did not produce significant benefit in HF care
Key takeaways:
- Hospital participation in the CMS bundled payments program may not affect quality of care of patients hospitalized with HF.
- Thirty- and 90-day readmission and mortality remained similar vs. nonparticipating hospitals.
Hospital participation in the CMS Bundled Payments for Care Improvement Advanced program was not associated with significant change in quality of care metrics for patients hospitalized with HF, researchers reported.
“In 2013, the CMS Innovation Center launched one of the largest experiments to date with the Bundled Payments for Care Improvement (BPCI) program,” D. August Oddleifson, MD, MBA, resident in internal medicine at Beth Israel Deaconess Medical Center, and colleagues wrote. “The program continued until 2018, when it was replaced by BPCI Advanced. The original BPCI aimed to lower costs and improve quality of care by aligning incentives for acute and post-acute clinicians and improving coordination of care.”
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To gauge the success of the bundled payment program, Oddleifson and colleagues used data from both the American Heart Association’s Get with the Guidelines – Heart Failure registry and Medicare claims to compare changes in process-of-care and outcome measures among patients hospitalized with HF.
Their analysis included 8,721 patients hospitalized at 23 participating hospitals and 94,530 patients hospitalized at 224 same-state nonparticipating hospitals (29.8% aged 75 years; 53% women).
The study was published in JAMA Cardiology.
Compared with same-state nonparticipating hospitals, participation in the BPCI Advanced program was not associated with significant change in various process-of-care measures during HF hospitalization, except for decreased odds of receiving evidence-based beta-blockers at discharge (adjusted OR = 0.63; 95% CI, 0.41-0.98; P = .04), researchers reported.
Similarly, participation in the bundled payment program was not associated with significant change in odds of receiving ACE inhibitor/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, aldosterone, cardiac resynchronization therapy, pacemaker, implantable cardioverter defibrillator counseling, ICD implant or HF education at discharge or having a follow-up visit within 7 days, according to the study.
Moreover, participation was not associated with a significant differential change in 30-day or 90-day all-cause readmission or mortality compared with same-state nonparticipating hospitals; however, participation was associated with a decrease in odds of in-hospital mortality (aOR = 0.67; 95% CI, 0.51-0.86; P = .002).
“The program was found to be associated with lower in-hospital mortality. However, as in-hospital mortality may be influenced by variations in length of stay and transfers out, and there were no significant differences in 30-day mortality rates, these results should be interpreted with caution. The overall findings of this study are consistent with prior studies that have shown no effect of BPCI on 30-day and 90-day risk-adjusted all-cause readmission and mortality,” the researchers wrote. “This adds to the growing body of evidence that the original BPCI program was not successful in achieving its goal of increasing care quality while reducing cost to Medicare.”
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