Association of Patient Outcomes With Bundled Payments Among Hospitalized Patients Attributed to Accountable Care Organizations

Published on Aug 3, 2021
· DOI :10.1001/JAMAHEALTHFORUM.2021.2131
Jingsan Zhu3
Estimated H-index: 3
(UPenn: University of Pennsylvania)
Source
Abstract
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 January 1, 2011, to September 30, 2016, and difference-in-differences analysis to compare episode outcomes for patients admitted to BPCI vs non-BPCI hospitals. Outcomes were stratified for patients who were and were not attributed to an ACO. Participants included Medicare fee-for-service beneficiaries receiving care for medical and surgical episodes at US hospitals. Data were analyzed between October 1, 2018, and June 10, 2021. null Exposures null Hospitalization for any of the 48 episodes (24 medical, 24 surgical) included in the BPCI at US hospitals participating in the BPCI for those episodes. null Main Outcomes and Measures null The primary outcome was change in 90-day postdischarge institutional spending, and secondary outcomes included changes in quality and utilization. null Results null A total of 7 108 146 beneficiaries (mean [SD] age, 76.9 [12.2] years; 4 101 081 women [58%]) received care for medical episodes, and 3 675 962 beneficiaries (mean [SD] age, 74.8 [10.1] years; 2 074 921 women [56%]) received care for surgical episodes. Compared with patients who were not attributed to ACOs, the association between bundled payments and changes in postdischarge institutional spending was larger among patients attributed to ACOs (–323 difference; 95% CI, –07 to –$39;P = .03) for medical episodes, but not surgical episodes. Attribution to an ACO also increased the strength of the association between bundled payments and changes in 90-day readmissions for both medical episodes (−0.98 percentage point difference; 95% CI, –1.55 to –0.41;P = .001) and surgical episodes (−0.84 percentage point difference; 95% CI, −1.32 to −0.35;P = .001). null Conclusions and Relevance null In this cohort study, compared with inclusion in bundled payments alone, simultaneous inclusion in both ACOs and bundled payment programs was associated with lower institutional postacute care spending and readmissions for medical episodes and lower readmissions but not spending for surgical episodes. Receiving care under models such as ACOs may improve episode outcomes under bundled payments.
References27
Newest
#1Amol S. NavatheH-Index: 17
#2Claire T. Dinh (UPenn: University of Pennsylvania)H-Index: 5
Last. Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 14
view all 5 authors...
: Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BP...
Source
#1Rajender AgarwalH-Index: 16
#2Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 14
Last. Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 17
view all 4 authors...
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...
Source
#1Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 17
#2Ezekiel J. Emanuel (UPenn: University of Pennsylvania)H-Index: 107
Last. Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 14
view all 14 authors...
Medicare has reinforced its commitment to voluntary bundled payment by building upon the Bundled Payments for Care Improvement (BPCI) initiative via an ongoing successor program, the BPCI Advanced ...
Source
#1Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 14
#2Ezekiel J. Emanuel (Leonard Davis Institute of Health Economics)H-Index: 107
Last. Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 17
view all 10 authors...
Importance An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes given the prevalence of LEJR among patients receiving care at ACO participant organizations and potential overlap in care redesign strategies adopted ...
Source
#1Divyansh Agarwal (UPenn: University of Pennsylvania)H-Index: 10
#2Rachel M. Werner (Leonard Davis Institute of Health Economics)H-Index: 44
OBJECTIVE: To test for differences in patient outcomes when hospital and post-acute care (PAC) providers participate in accountable care organizations (ACOs). DATA/SETTING: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO-participating hospitals and PAC providers. DESIGN: We compared changes in outcomes among patients discharged from ACO-participating hospitals/PACs before and after participation to changes among pati...
Source
#1J. Michael McWilliams (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 36
#2Laura A. Hatfield (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 22
Last. Michael E. Chernew (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 67
view all 5 authors...
Abstract Background Health care providers who participate as an accountable care organization (ACO) in the voluntary Medicare Shared Savings Program (MSSP) have incentives to lower spending for Medicare patients while achieving high performance on a set of quality measures. Little is known about the extent to which early savings achieved by ACOs in the program have grown and been replicated by ACOs that entered the program in later years. ACOs that are physician groups have stronger incentives t...
Source
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...
Source
OBJECTIVES: To describe the extent of and longitudinal changes in physician practice variation with respect to implant costs, institutional postacute care (PAC) provider utilization, and total episode payments, as well as to evaluate the association between physician volume and quality and these outcomes. STUDY DESIGN: Observational study. METHODS: We combined claims and internal hospital cost data for 34 physicians responsible for 3614 joint replacement episodes under bundled payment at Baptist...
#1Amol S. Navathe (UPenn: University of Pennsylvania)H-Index: 17
#2Alexander M. Bain (UPenn: University of Pennsylvania)H-Index: 3
Last. Rachel M. Werner (UPenn: University of Pennsylvania)H-Index: 44
view all 3 authors...
Background While early evidence suggests that Medicare accountable care organizations (ACOs) may reduce post-acute care (PAC) utilization for attributed beneficiaries, whether these effects spill over to all beneficiaries admitted to hospitals participating in ACOs stray is unknown.
Source
#1Amol S. NavatheH-Index: 17
#2Joshua M. Liao (UW: University of Washington)H-Index: 14
Last. Ezekiel J. Emanuel (UPenn: University of Pennsylvania)H-Index: 107
view all 7 authors...
Source
Cited By1
Newest
#1David Schwartzman (WashU: Washington University in St. Louis)H-Index: 2
#2Kyle H Sheetz (UCSF: University of California, San Francisco)
Last. A. Mark Fendrick (UM: University of Michigan)H-Index: 62
view all 3 authors...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.