Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Hosp Med. 2020 Jun;15(6):356-359. doi: 10.12788/jhm.3288.
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 BPCI episodes, while overlap as a share of all bundled payment patients increased from 19% to 27%. Overlap from the perspectives of both ACO and bundled payments varied by specific episode. In the first description of overlap between ACOs and bundled payments, one in every ten MSSP patients received care under BPCI by the end of our study period, whereas more than one in every four patients receiving care under BPCI were also attributed to MSSP. Policymakers should consider strategies to address the clinical and policy implications of increasing payment model overlap.
责任医疗组织（ACO）和打包支付代表了突出的基于价值的支付模式，但这两种模式之间的重叠程度尚未描述。我们使用医疗保险数据，根据医疗保险储蓄计划（MSSP）ACO 的归属和 BPCI 参与医院的捆绑支付改善（BPCI）病例的住院情况来定义重叠。在 2013 年至 2016 年间，BPCI 病例中重叠作为 ACO 患者的比例从 2.7%增加到 10%，而重叠作为所有捆绑支付患者的比例从 19%增加到 27%。从 ACO 和捆绑支付的角度来看，重叠情况因具体病例而异。在描述 ACO 和捆绑支付之间的重叠情况的第一个例子中，我们研究期间结束时，每 10 名 MSSP 患者中就有 1 名接受了 BPCI 下的治疗，而在接受 BPCI 治疗的患者中，超过 4 名中有 1 名也被归因于 MSSP。政策制定者应考虑采取策略来应对支付模式重叠不断增加所带来的临床和政策影响。
