Bundled payment program associated with savings for medical, surgical episodes
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Key takeaways:
- The Bundled Payments for Care Improvement–Advanced program was associated with “modest savings” in Medicare payments, researchers wrote.
- The program was linked with savings for medical and surgical episodes.
According to published results, the Bundled Payments for Care Improvement–Advanced program was associated with savings of $882 for medical episodes and $587 for surgical or procedural episodes.
Keenan J. Robbins, MD, MPHS, a general surgery resident at Washington University School of Medicine in St. Louis, and colleagues used Medicare fee-for-service inpatient claims to perform a retrospective difference-in-differences cohort study of 2,895,878 medical and surgical episodes performed between January 2017 and September 2019 with minimum 90-day follow-up.
According to the study, 2,341,945 episodes were managed medically and 553,933 episodes were managed surgically or procedurally. Common medical diagnoses included cardiac arrhythmia, pneumonia or respiratory infections, congestive heart failure, chronic obstructive pulmonary disease and urinary tract infection. Common surgeries included spinal fusion, joint replacement, fracture fixation and percutaneous coronary intervention.
Robbins and colleagues compared outcomes between hospitals that participated in the Bundled Payments for Care Improvement–Advanced (BPCI-A) program with a matched cohort of nonparticipant hospitals. They assessed Medicare payments per episode and clinical outcomes, such as discharge disposition and length of stay.
Compared with nonparticipant hospitals, hospitals that participated in the BPCI-A program were associated with decreased payments of $882 per medical episode and decreased payments of $587 per surgical episode.
In addition, Robbins and colleagues found participation in the BPCI-A program was associated with a greater increase in healthy days at home and a greater decrease in discharges to a skilled nursing facility and length of stay at a skilled nursing facility. They noted no differences in these outcomes between medical and surgical episodes.
“The BPCI-A program was associated with modest savings for both medical and surgical episodes,” Robbins and colleagues wrote in the study. “This study does not support a hypothesis that either medical or surgical episodes are better-suited for episode-based payments,” they concluded.
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