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Published on: February 19, 2021
Patient-reported Outcomes Among Vulnerable Populations in the Medicare Bundled Payments for Care Improvement
Sean R McClellan1, Matthew J Trombley2, Brandon C Maughan3
1Abt Associates, Cambridge, MA.
Background:
The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative tested whether episode-based payment models could reduce Medicare payments without harming quality. Among patients with vulnerabilities, BPCI appeared to effectively reduce payments while maintaining the quality of care. However, these findings could overlook potential adverse patient-reported outcomes in this population.
Research Design:
We surveyed beneficiaries with 4 characteristics (Medicare-Medicaid dual eligibility; dementia; recent institutional care; or racial/ethnic minority) treated at BPCI-participating or comparison hospitals for congestive heart failure, sepsis, pneumonia, or major joint replacement of the lower extremity. We estimated risk-adjusted differences in patient-reported outcomes between BPCI and comparison respondents, stratified by clinical episode and vulnerable characteristic.
Measures:
Patient care experiences during episodes of care and patient-reported functional outcomes assessed roughly 90 days after hospitalization.
Results:
We observed no differences in self-reported functional improvement between BPCI and comparison respondents with vulnerable characteristics. Patient-reported care experience was similar between BPCI and comparison respondents in 11 of 15 subgroups of clinical episode and vulnerability. BPCI respondents with congestive heart failure, sepsis, and pneumonia were less likely to indicate positive care experiences than comparison respondents for at least 1 subgroup with vulnerabilities.
Conclusions:
As implemented by hospitals, BPCI Model 2 was not associated with adverse effects on patient-reported functional status among beneficiaries who may be vulnerable to reductions in care. Hospitals participating in heart failure, sepsis or pneumonia bundled payment episodes should focus on patient care experience while implementing changes in care delivery.
Insights
The Bundled Payments for Care Improvement (BPCI) initiative did not negatively impact functional status for vulnerable patients. However, some patients reported poorer care experiences in BPCI heart failure, sepsis, and pneumonia episodes.
Area of Science:
- Health economics
- Patient-centered outcomes research
- Healthcare policy
Background:
- The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative aimed to reduce Medicare payments via episode-based models without compromising quality.
- Initial findings suggested BPCI effectively reduced payments and maintained quality for vulnerable populations, but potential adverse patient-reported outcomes were not fully assessed.
Purpose of the Study:
- To evaluate the impact of BPCI on patient-reported functional outcomes and care experiences among vulnerable Medicare beneficiaries.
- To identify any adverse effects of BPCI implementation on specific patient subgroups and clinical episodes.
Main Methods:
- A survey was administered to beneficiaries with characteristics such as dual eligibility, dementia, recent institutional care, or minority status.
- Outcomes were assessed for patients undergoing treatment for congestive heart failure, sepsis, pneumonia, or major joint replacement at BPCI-participating or comparison hospitals.
- Risk-adjusted differences in patient-reported outcomes were estimated, stratified by clinical episode and vulnerability.
Main Results:
- No significant differences in self-reported functional improvement were found between BPCI and comparison groups for vulnerable beneficiaries.
- Patient-reported care experiences were largely similar, except for BPCI patients with congestive heart failure, sepsis, and pneumonia, who reported fewer positive experiences in certain subgroups.
- Out of 15 subgroups analyzed, 11 showed no difference in care experience between BPCI and comparison groups.
Conclusions:
- BPCI Model 2, as implemented, did not adversely affect patient-reported functional status in vulnerable populations.
- Hospitals involved in BPCI for heart failure, sepsis, or pneumonia should prioritize enhancing patient care experiences during care delivery redesign.
- Further focus on patient-reported outcomes is crucial for bundled payment models involving vulnerable individuals.
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