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Implementation of BPCI in private practice did not significantly lower costs for lumbar spine fusion
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ORLANDO, Fla. — Use of the CMS Bundled Payment for Care Improvement model in a private practice setting was not associated with significantly lower expenditures for lumbar spine fusion procedures, according to a presenter here.
“Overall, at our private practice, we were successful for [Bundled Payment for Care Improvement] BPCI,” Susan Odum, PhD, said during her presentation at the North American Spine Society Annual Meeting. “We believe that using [diagnosis-related groups] DRGs for lumbar fusion bundles is not ideal due to the relatively high variability and low volume. Future lumbar spine bundles should be designed by [current procedural terminology] CPT rather than DRG, and we hope to see that difference come to fruition. For this reason, we discontinued BPCI early for all spine DRGs”
Odum and colleagues compared 323 patients who underwent lumbar fusion surgery within a traditional fee-for-service model with a group of 177 Medicare patients who underwent surgery within the BPCI model. Researchers analyzed expenditures of lumbar fusion DRGs 459 and 460 and post-acute events within the 90-day episode of care, which included admission to an inpatient rehabilitation facility, skilled nursing facility, home health and readmissions. Differences between the two groups were determined with Wilcoxon tests and a multivariate generalized estimating equation.
Results showed the median expenditure for patients within the traditional model and those within the BPCI model was $24,782 and $24,113, respectively. Patients within the BPCI model had a higher rate of skilled nursing facility admissions and home health admissions compared with those within the traditional model. Readmissions and inpatient rehabilitation facility admission rates were lower for patients within the BPCI model.
Groups were not significantly different with regard to the total post-acute expenditures. Admission to the inpatient rehabilitation facility increased cost by 45% compared with a 28% increase in cost for admissions to a skilled nursing facility. There was a 10% increase in expenditures due to the use of home health. Costs increased by 43% due to 90-day readmissions. – by Monica Jaramillo
Reference:
Odum S, et al. Paper #48. Presented at: North American Spine Society Annual Meeting; Oct. 25-28, 2017; Orlando, Fla.
Disclosure: Odum reports no relevant financial disclosures.