Washington University School of Medicine, St Louis, Missouri.
Brigham and Women's Hospital, Boston, Massachusetts.
J Am Geriatr Soc. 2019 May;67(5):1027-1035. doi: 10.1111/jgs.15803. Epub 2019 Feb 25.
Bundled payments, in which services provided around a care episode are linked together, are being tested under Medicare's Bundled Payments for Care Improvement (BPCI) program. Reducing post-acute care (PAC) is critical under bundled payment, but little is known about whether this is done through provider selection or consolidation, and whether particular patterns of changes in PAC are associated with success under the program.
To characterize patterns of change in PAC under lower-extremity joint replacement episodes in BPCI.
Retrospective difference-in-differences study.
US Medicare, 2013 to 2015.
A total of 264 US hospitals participating in BPCI for lower-extremity joint replacement and matched controls.
Participation in BPCI.
Use and duration of institutional PAC (proportion discharged to a skilled nursing facility, an inpatient rehabilitation facility, and a long-term care hospital), dispersion of PAC (proportion of discharges to commonly used providers), and quality of PAC (Star Ratings, readmission rates, length of stay, and nurse staffing); part A Medicare payments.
BPCI participants decreased the use and duration of institutional PAC compared to controls: overall institutional PAC declined 4.4% in BPCI hospitals vs 2.1% in non-BPCI hospitals (difference = -2.2%; P = .033), and duration decreased by 1.6 days in BPCI hospitals compared to 0.0 days in non-BPCI hospitals (difference in differences = -1.5 days; P < .001). However, BPCI participants did not change their PAC referral patterns to reduce dispersion or refer patients to higher-quality PAC providers. Hospitals that were more successful in reducing Medicare payments started with higher payments and higher use of institutional PAC settings and demonstrated greater drops in use and duration of institutional PAC, but no differences in dispersion or referral to high-quality providers.
Reductions in spending under BPCI were driven by a shift from higher- to lower-cost discharge settings, and by shortening the duration of institutional PAC. Hospitals that reduced payments the most had the highest spending at baseline. J Am Geriatr Soc 67:1027-1035, 2019.
在医疗保险的捆绑支付改善计划（BPCI）下，正在测试将医疗服务捆绑在一起的捆绑支付。在捆绑支付下，减少急性后期护理（PAC）至关重要，但尚不清楚这是通过供应商选择还是整合来实现的，以及 PAC 的特定变化模式是否与该计划的成功相关。
描述 BPCI 下肢关节置换手术中 PAC 的变化模式。
回顾性差异差异研究。
美国医疗保险，2013 年至 2015 年。
共有 264 家参与 BPCI 下肢关节置换的美国医院和匹配对照组。
参与 BPCI。
机构 PAC 的使用和持续时间（出院到熟练护理机构、住院康复机构和长期护理医院的比例）、PAC 的分散程度（常用提供者的出院比例）和 PAC 的质量（星级评定、再入院率、住院时间和护士人员配备）；A 部分医疗保险付款。
与对照组相比，BPCI 参与者减少了机构 PAC 的使用和持续时间：BPCI 医院的整体机构 PAC 下降了 4.4%，而非 BPCI 医院下降了 2.1%（差异=-2.2%；P=0.033），BPCI 医院的持续时间减少了 1.6 天，而非 BPCI 医院的持续时间减少了 0.0 天（差异差异=-1.5 天；P<0.001）。然而，BPCI 参与者并没有改变他们的 PAC 转诊模式来减少分散或将患者转介给高质量的 PAC 提供者。在降低医疗保险支付方面更为成功的医院，其支付额较高，机构 PAC 设置的使用率较高，机构 PAC 的使用率和持续时间下降幅度较大，但在分散程度或向高质量提供者转诊方面没有差异。
BPCI 下支出的减少是由从高成本出院环境向低成本出院环境转变以及缩短机构 PAC 持续时间驱动的。降低支付最多的医院基线支出最高。J Am Geriatr Soc 67：1027-1035，2019。
Zotero 插件