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Medicare's bundled payment model did not change skilled nursing facility discharge patterns
Jane M Zhu1, Amol Navathe, Yihao Yuan
1Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
The American Journal of Managed Care
|July 19, 2019
Summary
Bundled Payments for Care Improvement (BPCI) participation did not alter hospital discharge referral patterns to skilled nursing facilities (SNFs). This study found no significant changes in the number of SNF partners or discharge concentration for BPCI hospitals.
Area of Science:
- Health Services Research
- Health Economics
- Healthcare Policy
Background:
- Medicare's voluntary Bundled Payments for Care Improvement (BPCI) initiative aims to incentivize cost and quality improvements.
- Understanding the impact of BPCI on hospital referral patterns to post-acute care, specifically skilled nursing facilities (SNFs), is crucial for evaluating its effectiveness.
Purpose of the Study:
- To evaluate whether participation in the BPCI model was associated with changes in discharge referral patterns to SNFs.
- Specifically, to assess changes in the number of SNF partners and discharge concentration among BPCI-participating hospitals.
Main Methods:
- Retrospective observational study utilizing Medicare claims data from 2010 to 2015.
- Difference-in-differences analysis comparing BPCI-participating hospitals with matched control hospitals for lower joint replacement and specific medical conditions.
- Analytic sample included 3078 acute care hospitals and 14,866 Medicare-certified SNFs, covering over 47 million discharges.
Main Results:
- BPCI participation was not associated with significant changes in the number of SNF partners (0.8 SNFs increase; 95% CI, -0.2 to 1.9; P = .11).
- No significant change was observed in discharge concentration, as measured by the Herfindahl-Hirschman Index (0.2 increase; 95% CI, -68.7 to 69.1; P = .36).
- Results remained consistent across various clinical conditions and BPCI participation durations.
Conclusions:
- Hospital participation in the BPCI model did not lead to changes in SNF referral patterns regarding partner numbers or discharge concentration.
- Further research is needed to understand hospital responses to bundled payment incentives and identify practices that enhance cost and quality outcomes.