Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA.
Inova Health System, Falls Church, VA.
J Arthroplasty. 2019 Oct;34(10):2284-2289. doi: 10.1016/j.arth.2019.05.011. Epub 2019 May 13.
The Bundled Payments for Care Improvement (BPCI) initiative was introduced in 2013 to reduce Medicare healthcare costs while preserving or enhancing quality. We examined data from a metropolitan healthcare system comprised of 1 higher volume hospital and 4 lower volume hospitals that voluntarily elected to participate in the BPCI Major Joint Replacement of the Lower Extremity Model 2, beginning July 1, 2015. Stratifying the data by hospital volume, we determined how costs changed during the 16-month period when all 5 hospitals participated compared to the 1-year period preceding BPCI participation, where savings were achieved, and how the hospitals were rewarded.
The Medicare data included the 90-day target for each episode and actual part A and part B spending for the anchor hospitalization plus all post-acute payments including inpatient rehabilitation, skilled nursing, home health, outpatient physical therapy, and hospital readmissions.
The mean episode of care cost decreased by 11.1% (from $21,324 to $18,953) at the higher volume hospitals and by 8.3% (from $25,724 to $23,584) at the lower volume hospitals during BPCI participation compared to the preceding year. The savings were achieved by reducing the use of inpatient rehabilitation, shortening the length of stay at skilled nursing facilities, and decreasing readmission rates. Although the higher volume hospital achieved an increased mean savings of $230 per episode compared to the lower volume hospitals ($2371 vs $2141), it was penalized $490 per episode after reconciling the actual Medicare expenditures with the BPCI targets while the lower volume hospitals received a mean reward of $315 per episode.
The BPCI initiative decreased costs and readmissions within our healthcare system. Despite substantial savings compared to the preceding year, the higher volume hospital's low target derived from its 2009-2012 baseline costs was not achieved which resulted in a penalty and led it to withdraw from the BPCI initiative in October 2016.
BPCI 计划于 2013 年推出，旨在降低医疗保险医疗成本，同时保持或提高质量。我们检查了一个由 1 家高容量医院和 4 家低容量医院组成的大都市医疗系统的数据，这些医院自愿选择参加 BPCI 下肢主要关节置换模型 2，从 2015 年 7 月 1 日开始。根据医院的容量对数据进行分层，我们确定了在所有 5 家医院参与的 16 个月期间成本如何变化，与 BPCI 参与之前的 1 年期间相比，在这期间实现了节约，以及医院是如何获得奖励的。
医疗保险数据包括每个病例的 90 天目标以及锚定住院治疗的实际 A 部分和 B 部分支出，以及所有急性后支付，包括住院康复、熟练护理、家庭保健、门诊物理治疗和医院再入院。
在 BPCI 参与期间，高容量医院的医疗护理费用从$21324 降至$18953，降幅为 11.1%，低容量医院的费用从$25724 降至$23584，降幅为 8.3%。通过减少住院康复的使用、缩短熟练护理设施的住院时间和降低再入院率实现了节约。尽管高容量医院的平均每例节约$230，比低容量医院多$2141 ($2371 比$2141)，但在将实际医疗保险支出与 BPCI 目标相协调后，高容量医院每例被罚款$490，而低容量医院每例获得平均奖励$315。
BPCI 计划降低了我们医疗系统的成本和再入院率。尽管与前一年相比有了实质性的节约，但高容量医院的低目标是由其 2009-2012 年的基准成本决定的，这一目标没有实现，导致其被罚款，并于 2016 年 10 月退出 BPCI 计划。
