Taking Risk: Early Results From Teaching Hospitals' Participation in the Center for Medicare and Medicaid Innovation...

Area of Science:

• Health Policy
• Healthcare Economics
• Clinical Operations

Background:

• The Center for Medicare and Medicaid Innovation (CMMI) introduced the Bundled Payments for Care Improvement (BPCI) initiative in 2011 to encourage value-based care.
• BPCI involves Medicare payment arrangements where healthcare providers assume financial risk for defined episodes of care.
• The Association of American Medical Colleges (AAMC) facilitated a cohort of 27 teaching hospitals participating in the BPCI initiative.

Purpose of the Study:

• To analyze the initial observations and financial outcomes of teaching hospitals participating in the CMMI's BPCI initiative.
• To identify factors influencing savings and losses within bundled payment models for specific clinical episodes.
• To provide insights for future research on alternative payment models in healthcare.

Main Methods:

• Observations from 27 teaching hospitals within the AAMC cohort participating in the BPCI initiative.
• Analysis of financial results for selected episodes of care, including congestive heart failure (CHF), major joint replacement (MJR), and cardiac valve surgery.
• Evaluation of factors such as post-acute care utilization, care process changes, and team composition.

Main Results:

• The first cohort of BPCI participants generated savings in MJR, CHF, and cardiac valve surgery episodes.
• Losses were observed in episodes including stroke, percutaneous coronary intervention, and spine surgery.
• Early financial performance was influenced by post-acute care management, care process modifications, and program pricing.

Conclusions:

• Focused efforts on post-acute care, process improvements, and team dynamics significantly impacted BPCI program outcomes.
• Despite participation from a quarter of U.S. teaching hospitals, the evolving landscape of payment models necessitates ongoing evaluation of BPCI.
• Further research into alternative payment models is recommended given the proliferation of new payment strategies and the shift towards value-based reimbursement.