Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. Email:
Am J Manag Care. 2019 Jul;25(7):329-334.
To evaluate whether participation in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration.
Retrospective observational study using difference-in-differences analysis.
We used Medicare claims data from 2010 to 2015 to identify admissions for lower joint replacement surgery and the following medical conditions: congestive heart failure, renal failure, sepsis, pneumonia, urinary tract and kidney infections, chronic obstructive pulmonary disease, and stroke. We used difference-in-differences analyses to assess changes in discharge patterns among BPCI-participating hospitals compared with matched control hospitals.
Our analytic sample included 3078 acute care hospitals and 14,866 Medicare-certified SNFs in the United States, encompassing more than 47 million hospital discharges. Of these hospitals, 416 participated in BPCI, with the majority selecting into joint replacement episodes (n = 295). BPCI participation was not associated with any change in number of SNF partners (increase by 0.8 SNFs among BPCI hospitals relative to non-BPCI hospitals; 95% CI, -0.2 to 1.9; P = .11) or in discharge concentration (increase in Herfindahl-Hirschman Index of 0.2 among BPCI hospitals relative to non-BPCI hospitals; 95% CI, -68.7 to 69.1; P = .36). Results did not vary across clinical conditions and were robust across duration of BPCI participation and with different comparison groups.
Hospital participation in BPCI was not associated with changes in the number of SNF partners or in discharge concentration relative to non-BPCI hospitals. More research is needed to understand how hospitals are responding to bundled payment incentives and specific practices that contribute to improvements in cost and quality.
评估参与联邦医疗保险（Medicare）自愿捆绑支付改善计划（BPCI）是否与向熟练护理机构（SNF）的出院转介模式的变化相关，特别是 SNF 合作伙伴的数量和出院集中程度。
使用差异中的差异分析进行回顾性观察研究。
我们使用 2010 年至 2015 年的 Medicare 索赔数据，确定接受下关节置换手术和以下医疗条件的入院人数：充血性心力衰竭、肾衰竭、败血症、肺炎、尿路感染和肾脏感染、慢性阻塞性肺疾病和中风。我们使用差异中的差异分析来评估与匹配对照组医院相比，参与 BPCI 的医院出院模式的变化。
我们的分析样本包括美国 3078 家急性护理医院和 14866 家经 Medicare 认证的 SNF，涵盖超过 4700 万次住院出院。在这些医院中，有 416 家参与了 BPCI，其中大多数选择参与关节置换手术（n=295）。BPCI 参与与 SNF 合作伙伴数量的任何变化均无关（与非 BPCI 医院相比，BPCI 医院的 SNF 合作伙伴增加了 0.8 个；95%置信区间，-0.2 至 1.9；P=0.11）或出院集中程度（BPCI 医院的 Herfindahl-Hirschman 指数增加 0.2，而非 BPCI 医院的 Herfindahl-Hirschman 指数增加 0.2；95%置信区间，-68.7 至 69.1；P=0.36）。结果在不同的临床条件下没有差异，并且在 BPCI 参与的持续时间和不同的比较组中都具有稳健性。
与非 BPCI 医院相比，医院参与 BPCI 与 SNF 合作伙伴数量或出院集中程度的变化无关。需要进行更多的研究，以了解医院对捆绑支付激励措施的反应以及有助于提高成本和质量的具体做法。
