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Bundled Payment Episodes Initiated by Physician Group Practices: Medicare Beneficiary Perceptions of Care Quality
Sean R McClellan1, Matthew J Trombley2, Jaclyn Marshall3
1Abt Associates, Cambridge, MA, USA. Sean_McClellan@abtassoc.com.
Background:
The Bundled Payments for Care Improvement (BPCI) initiative incentivizes participating providers to reduce total Medicare payments for an episode of care. However, there are concerns that reducing payments could reduce quality of care.
Objective:
To assess the association of BPCI with patient-reported functional status and care experiences.
Design:
We surveyed a stratified random sample of Medicare beneficiaries with BPCI episodes attributed to participating physician group practices, and matched comparison beneficiaries, after hospitalization for one of the 18 highest volume clinical episodes. The sample included beneficiaries discharged from the hospital from February 2017 through September 2017. Beneficiaries were surveyed approximately 90 days after their hospital discharge. We estimated risk-adjusted differences between the BPCI and comparison groups, pooled across all 18 clinical episodes and separately for the five largest clinical episodes.
Participants:
Medicare beneficiaries with BPCI episodes (n=16,898, response rate=44.5%) and comparison beneficiaries hospitalized for similar conditions selected using coarsened exact matching (n=14,652, response rate=46.2%).
Main Measures:
Patient-reported functional status, care experiences, and overall satisfaction with recovery.
Key Results:
Overall, we did not find differences between the BPCI and comparison respondents across seven measures of change in functional status or overall satisfaction with recovery. Both BPCI and comparison respondents reported generally positive care experiences, but BPCI respondents were less likely to report positive care experience for 3 of 8 measures (discharged at the right time, -1.2 percentage points (pp); appropriate level of care, -1.8 pp; preferences for post-discharge care taken into account, -0.9 pp; p<0.05 for all three measures).
Conclusions:
The proportion of respondents with favorable care experiences was smaller for BPCI than comparison respondents. However, we did not detect differences in self-reported change in functional status approximately 90 days after hospital discharge, indicating that differences in care experiences did not affect functional recovery.
Insights
Bundled Payments for Care Improvement (BPCI) did not impact patient functional status or satisfaction. However, BPCI beneficiaries reported slightly worse care experiences, suggesting a need to monitor quality in payment reform initiatives.
Area of Science:
- Health Services Research
- Health Economics
- Quality Improvement
Background:
- The Bundled Payments for Care Improvement (BPCI) initiative aims to reduce Medicare healthcare costs by incentivizing providers to lower payments for episodes of care.
- Concerns exist that payment reductions in BPCI may negatively impact the quality of patient care.
Purpose of the Study:
- To evaluate the association between the BPCI initiative and patient-reported outcomes, specifically functional status and experiences with care.
- To determine if BPCI participation influences patient satisfaction with recovery.
Main Methods:
- A survey was administered to Medicare beneficiaries participating in BPCI and a matched comparison group.
- Participants were hospitalized for one of 18 high-volume clinical episodes and surveyed approximately 90 days post-discharge.
- Risk-adjusted differences in functional status and care experiences were analyzed between BPCI and comparison groups.
Main Results:
- No significant differences were found in patient-reported functional status or overall satisfaction with recovery between BPCI and comparison groups.
- While both groups reported positive care experiences, BPCI respondents were less likely to report positive experiences in three specific areas: timely discharge, appropriate care level, and consideration of post-discharge preferences.
- These differences in care experiences did not correlate with functional recovery outcomes.
Conclusions:
- The BPCI initiative did not adversely affect patient-reported functional status or satisfaction with recovery.
- A slight decrease in favorable care experiences was observed among BPCI participants, highlighting potential areas for quality monitoring within payment reform programs.
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