The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review.

Published on Jan 6, 2020in Health Affairs6.301
路 DOI :10.1377/HLTHAFF.2019.00784
Rajender Agarwal16
Estimated H-index: 16
,
Joshua M. Liao14
Estimated H-index: 14
(Leonard Davis Institute of Health Economics)
+ 1 AuthorsAmol S. Navathe17
Estimated H-index: 17
(Leonard Davis Institute of Health Economics)
Sources
Abstract
The Centers for Medicare and Medicaid Services (CMS) has promoted bundled payment programs nationwide as one of its flagship value-based payment reforms. Under bundled payment, providers assume acc...
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References29
Newest
#1Wesley H Bronson (NYU: New York University)H-Index: 6
#2Matthew T. KingeryH-Index: 9
Last. John A. BendoH-Index: 26
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Study Design.Retrospective analysis of Medicare claims and procedure details from a single institution participation in the Bundled Payments for Care Improvement (BPCI) program.Objective.To analyze the effects of the BPCI program on patient outcome metrics and cost data.Summary of Background Data.Th
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Abstract Background In 2016, Medicare implemented Comprehensive Care for Joint Replacement (CJR), a national mandatory bundled-payment model for hip or knee replacement in randomly selected metropo...
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#1Aaron Glickman (UPenn: University of Pennsylvania)H-Index: 8
#2Claire T. Dinh (UPenn: University of Pennsylvania)H-Index: 5
Last. Amol S. Navathe (UPenn: University of Pennsylvania)H-Index: 17
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: A review of the evidence shows that bundled payments for surgical procedures can generate savings without adversely affecting patient outcomes. Less is known about the effect of bundled payments for chronic medical conditions, but early evidence suggests that cost and quality improvements may be small or non-existent. There is little evidence that bundles reduce access and equity, but continued monitoring is required.
#1Amy Finkelstein (MIT: Massachusetts Institute of Technology)H-Index: 64
#2Yunan Ji (Harvard University)H-Index: 4
Last. Jonathan Skinner (Dartmouth College)H-Index: 87
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Importance Bundled payments are an increasingly common alternative payment model for Medicare, yet there is limited evidence regarding their effectiveness. Objective To report interim outcomes from the first year of implementation of a bundled payment model for lower extremity joint replacement (LEJR). Design, Setting, and Participants As part of a 5-year, mandatory-participation randomized trial by the Centers for Medicare & Medicaid Services, eligible metropolitan statistical areas (MSAs) were...
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#1Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 17
#2Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 14
Last. Ezekiel J. Emanuel (Leonard Davis Institute of Health Economics)H-Index: 107
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Importance Medicare鈥檚 Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with a reduction in episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes paid for by Medicare, which could potentially eliminate program-related savings or prompt them to shift case mix to lower-risk patients. Objective To evalua...
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#1Mark A. Cairns (UNC: University of North Carolina at Chapel Hill)H-Index: 3
#2Peter T Moskal (UNC: University of North Carolina at Chapel Hill)H-Index: 2
Last. R. Carter Clement (UNC: University of North Carolina at Chapel Hill)H-Index: 14
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Abstract Background Bundled payments are meant to reduce costs and improve quality of care. Without adequate risk adjustment, bundling may be inequitable to providers and restrict access for certain patients. This study examines patient factors that could improve risk stratification for the Comprehensive Care for Joint Replacement (CJR) bundled-payment program. Methods Ninety-five thousand twenty-four patients meeting the CJR criteria were retrospectively reviewed using administrative Medicare d...
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#1P. Maxwell Courtney (Thomas Jefferson University Hospital)H-Index: 13
#2Daniel D. Bohl (Rush University Medical Center)H-Index: 41
Last. Craig J. Della Valle (Rush University Medical Center)H-Index: 83
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Abstract Background Concerns exist that high-risk patients in alternative payment models may face difficulties with access to care without proper risk adjustment. The purpose of this study is to identify the effect of medical and orthopedic specific risk factors on the cost of a 90-day episode of care following total hip (THA) and knee arthroplasty (TKA). Methods We queried the Medicare 5% Limited Data Set for all patients undergoing primary THA and TKA from 2010 to 2014. To evaluate the cost of...
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Abstract Background The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. A subsequent study showed that the initiativ...
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#1Chancellor F. Gray (UF: University of Florida)H-Index: 13
#2Hernan A. Prieto (UF: University of Florida)H-Index: 9
Last. Hari K. Parvataneni (UF: University of Florida)H-Index: 16
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Abstract Background Total joint arthroplasty (TJA) remains the highest expenditure in the Centers for Medicare and Medicaid Services (CMS) budget. One model to control cost is the Comprehensive Care for Joint Replacement (CJR) model. There has been no published literature to date examining the efficacy of CJR on value-based outcomes. The purpose of this study was to determine the efficacy and sustainability of a multidisciplinary care redesign for total joint arthroplasty under the CJR paradigm ...
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#1Brook I. Martin (UofU: University of Utah)H-Index: 28
#2Jon D. Lurie (The Dartmouth Institute for Health Policy and Clinical Practice)H-Index: 64
Last. Sohail K. Mirza (The Dartmouth Institute for Health Policy and Clinical Practice)H-Index: 53
view all 5 authors...
Study Design. Retrospective analysis of Medicare claims linked to hospital participation in the Center for Medicare and Medicaid Innovation's episode-based Bundled Payment for Care Improvement (BPCI) program for lumbar fusion. Objective. To describe the early effects of BPCI participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. Summary of Background Data. Initiated on January 1, 2013, BPCI's voluntary bundle payment program provides a predetermi...
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Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 鈥榣ow-value鈥 interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In t...
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#1Kelby Brown (Duke University)H-Index: 2
#2Nada El Husseini (Duke University)H-Index: 11
Last. Brystana G. Kaufman (Duke University)H-Index: 9
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Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evaluates historical and current evidence regarding the impacts of alternative payment models on stroke outcomes, spending, and utilization. Included studies evaluated alternative payment models in 4 categories: pay-for-performance (n=3), prospective...
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#1Katie Coleman (KP: Kaiser Permanente)H-Index: 15
#2Chloe A. Krakauer (KP: Kaiser Permanente)H-Index: 1
Last. Michael L. Parchman (KP: Kaiser Permanente)H-Index: 40
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PURPOSE We undertook a study to assess whether implementing 7 evidence-based strategies to build improvement capacity within smaller primary care practices was associated with changes in performance on clinical quality measures (CQMs) for cardiovascular disease. METHODS A total of 209 practices across Washington, Oregon, and Idaho participated in a pragmatic clinical trial that focused on building quality improvement capacity as measured by a validated questionnaire, the 12-point Quality Improve...
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#1Ryan Hunter Rose (University of Arkansas for Medical Sciences)
#2Steven M. Cherney (University of Arkansas for Medical Sciences)H-Index: 9
Last. Simon C. Mears (University of Arkansas for Medical Sciences)H-Index: 30
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IntroductionThe Bundled Payment for Care Improvement (BPCI) for hip and femur fractures is an effort to increase care quality and coordination at a lower cost. The bundle includes all patients unde...
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#1Carmen E. Capo-Lugo (UAB: University of Alabama at Birmingham)H-Index: 5
#2Robert L. Askew (Stetson University)H-Index: 22
Last. Allen W. Heinemann (Rehabilitation Institute of Chicago)H-Index: 75
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ABSTRACT This study aims to compare delivery of acute rehabilitation therapy using metrics reflecting distinct aspects of rehabilitation therapy services. Seven general medical-surgical hospitals in Illinois and Indiana prospectively collected rehabilitation therapy data. De-identified data on all patients who received any type of acute rehabilitation therapy (n鈥=鈥35,449) were extracted and reported as aggregate of minutes of therapy services per discipline. Metrics included therapy types, total...
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#1Hyunkyu Ko (UofU: University of Utah)
#2Brook I. Martin (UofU: University of Utah)H-Index: 28
Last. Christopher E. Pelt (UofU: University of Utah)H-Index: 22
view all 4 authors...
OBJECTIVE To understand whether the Comprehensive Care for Joint Replacement (CJR) program induces participating hospitals to (1) preferentially select lower risk patients, (2) reduce 90-day episode-of-care costs, (3) improve quality of care, and (4) achieve greater cost reduction during its second year, when downside financial risk was applied. DATA SOURCES We identified beneficiaries of age 65鈥墆ears or older undergoing hip or knee joint replacement in the 100% sample of Medicare fee-for-servic...
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#1Nirav Kamdar (UCLA: University of California, Los Angeles)H-Index: 7
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#1Charlan D. Kroelinger (CDC: Centers for Disease Control and Prevention)H-Index: 17
#2Ekwutosi M. Okoroh (CDC: Centers for Disease Control and Prevention)H-Index: 13
Last. Shanna Cox (CDC: Centers for Disease Control and Prevention)H-Index: 24
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Abstract null null Background null Previous assessment of statewide policies on long-acting reversible contraception (LARC) indicate that an increasing number of states are implementing policies specifically for provision immediately postpartum, supported by current clinical guidelines. Less is known about how state policies describe payment methodologies for the insertion procedure and device costs. null null null Methods null We conducted a systematic, web-based review of publicly available st...
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#5Jingsan Zhu (UPenn: University of Pennsylvania)H-Index: 3
Importance null It is unknown how outcomes are affected when patients receive care under bundled payment and accountable care organization (ACO) programs simultaneously. null Objective null To evaluate whether outcomes in the Medicare Bundled Payments for Care Improvement (BPCI) program differed depending on whether patients were attributed to ACOs in the Medicare Shared Savings Program. null Design, Setting, and Participants null This cohort study was conducted using Medicare claims data from J...
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