Bundled Payment Programs and Changes in Practice Patterns and Episode Spending in Major Gastrointestinal Surgery

Area of Science:

• Health Economics
• Surgical Outcomes
• Healthcare Policy

Background:

• Bundled Payments for Care Improvement - Advanced (BPCI-A) aims to reduce healthcare costs and improve quality.
• Major gastrointestinal surgeries represent a significant cost center within the Medicare program.
• Minimally invasive surgery (MIS) is often associated with lower costs and improved patient outcomes.

Purpose of the Study:

• To evaluate the association between enrollment in the BPCI-A program and changes in minimally invasive surgery utilization.
• To assess the impact of BPCI-A participation on 90-day episode spending for major gastrointestinal surgeries.

Main Methods:

• Comparative study using Medicare claims and American Hospital Association data (2013-2021).
• Hospitals enrolled in BPCI-A were compared to non-participating control hospitals.
• Entropy balancing and difference-in-differences analysis were employed to control for confounding factors.

Main Results:

• No significant difference in 90-day episode payments between BPCI-A and control hospitals (-$172; 95% CI: -$1104 to $760).
• No significant difference in the utilization trends of minimally invasive surgical approaches between BPCI-A and control hospitals (RR difference: -0.003; 95% CI: -0.10 to 0.04).
• Overall utilization of MIS increased during the study period, irrespective of BPCI-A participation.

Conclusions:

• Hospitals participating in BPCI-A for major bowel surgery episodes showed no significant differences in episode spending.
• BPCI-A participation did not lead to significant changes in the utilization of minimally invasive surgical approaches.