Brandon C. Maughan (
Daver C. Kahvecioglu is a social science research analyst in the Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, in Baltimore, Maryland.
Health Aff (Millwood). 2019 Apr;38(4):561-568. doi: 10.1377/hlthaff.2018.05146.
The Bundled Payments for Care Improvement (BPCI) initiative established four models to test whether linking payments for an episode of care could reduce Medicare payments while maintaining or improving quality. Evaluations concluded that model 2, the largest, generally lowered payments without reducing quality for the average beneficiary, but these global results could mask adverse findings among vulnerable subpopulations. We analyzed changes in emergency department visits, unplanned hospital readmissions, and all-cause mortality within ninety days of hospital discharge among beneficiaries with one or more of three vulnerable characteristics-dementia, dual eligibility for Medicare and Medicaid, and recent institutional care-in 105,458 beneficiary episodes in the period October 2013-December 2016. The results for twelve types of medical and surgical BPCI episodes were evaluated relative to results in matched comparison groups. Our findings suggest that BPCI model 2 did not adversely affect care quality for beneficiaries with vulnerabilities. While this conclusion does not discourage the further development of bundled payment models, policy makers should support ongoing research to ensure that vulnerable populations are not adversely affected by these approaches.
支付方式捆绑改革（BPCI）倡议建立了四个模式，以测试是否将一次医疗护理的支付捆绑起来可以在维持或提高质量的同时降低医疗保险支付。评估结论认为，规模最大的模式 2 通常降低了平均受益人的支付，但没有降低质量，但这些全球结果可能掩盖了弱势人群中的不利发现。我们分析了在 2013 年 10 月至 2016 年 12 月期间，105458 名受益人的一个或多个三个弱势特征（痴呆、医疗保险和医疗补助的双重资格以及最近的机构护理）的急诊就诊、非计划再次住院和出院后 90 天内全因死亡率的变化。在与匹配的对照组进行比较后，评估了 12 种医疗和外科 BPCI 病例的结果。我们的研究结果表明，BPCI 模式 2 并没有对有脆弱性的受益人的护理质量产生不利影响。虽然这一结论并不反对进一步发展捆绑支付模式，但政策制定者应该支持正在进行的研究，以确保这些方法不会对弱势人群产生不利影响。
