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Medicare's Bundled Payments For Care Improvement Initiative Maintained Quality Of Care For Vulnerable Patients
Brandon C Maughan1, Daver C Kahvecioglu2, Grecia Marrufo3
1Brandon C. Maughan ( maughabr@ohsu.edu ) is an assistant professor in the Department of Emergency Medicine, Oregon Health and Science University, in Portland. He was a managing consultant at the Lewin Group, in Falls Church, Virginia, when most of this work was conducted.
Abstract:
The Bundled Payments for Care Improvement (BPCI) initiative established four models to test whether linking payments for an episode of care could reduce Medicare payments while maintaining or improving quality. Evaluations concluded that model 2, the largest, generally lowered payments without reducing quality for the average beneficiary, but these global results could mask adverse findings among vulnerable subpopulations. We analyzed changes in emergency department visits, unplanned hospital readmissions, and all-cause mortality within ninety days of hospital discharge among beneficiaries with one or more of three vulnerable characteristics-dementia, dual eligibility for Medicare and Medicaid, and recent institutional care-in 105,458 beneficiary episodes in the period October 2013-December 2016. The results for twelve types of medical and surgical BPCI episodes were evaluated relative to results in matched comparison groups. Our findings suggest that BPCI model 2 did not adversely affect care quality for beneficiaries with vulnerabilities. While this conclusion does not discourage the further development of bundled payment models, policy makers should support ongoing research to ensure that vulnerable populations are not adversely affected by these approaches.
Insights
Bundled Payments for Care Improvement (BPCI) model 2 generally improved healthcare affordability without compromising quality for vulnerable Medicare beneficiaries. This study found no adverse effects on emergency visits, readmissions, or mortality for these populations.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- The Bundled Payments for Care Improvement (BPCI) initiative aimed to reduce Medicare costs by linking payments for episodes of care.
- Previous evaluations indicated BPCI model 2 lowered payments without affecting overall quality.
- Concerns remained about potential adverse impacts on vulnerable patient groups.
Purpose of the Study:
- To assess the impact of BPCI model 2 on quality of care for vulnerable Medicare beneficiaries.
- To analyze emergency department visits, hospital readmissions, and mortality rates in specific at-risk populations.
Main Methods:
- Analysis of 105,458 BPCI episodes (October 2013-December 2016) involving beneficiaries with dementia, dual eligibility, or recent institutional care.
- Comparison of outcomes for twelve medical and surgical BPCI episode types against matched control groups.
- Evaluation of emergency department visits, unplanned readmissions, and 90-day all-cause mortality.
Main Results:
- BPCI model 2 did not demonstrate adverse effects on care quality for beneficiaries with vulnerabilities.
- No significant negative impact was observed on emergency department utilization or hospital readmission rates.
- All-cause mortality within 90 days post-discharge remained stable for vulnerable groups under BPCI model 2.
Conclusions:
- Bundled payment models, specifically BPCI model 2, appear safe for vulnerable populations regarding key quality indicators.
- Policy development for bundled payments should continue, with emphasis on ongoing monitoring of vulnerable groups.
- Further research is recommended to ensure equitable outcomes across all patient subpopulations in value-based care models.