医疗保险捆绑支付计划对经皮冠状动脉介入治疗和冠状动脉旁路移植术的患者选择、支付和结果的影响。

Impact of Medicare's Bundled Payments Initiative on Patient Selection, Payments, and Outcomes for Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting.

机构信息

Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Saint Louis, MO (C.M., K.E.J.M.).

Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.J.O.).

出版信息

Circ Cardiovasc Qual Outcomes. 2020 Sep;13(9):e006171. doi: 10.1161/CIRCOUTCOMES.119.006171. Epub 2020 Sep 1.

DOI:10.1161/CIRCOUTCOMES.119.006171

PMID:32867514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7660588/

Abstract

BACKGROUND

The Center for Medicare and Medicaid Innovation launched the Bundled Payments for Care Initiative (BPCI) in 2013. Its effect on payments and outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is unknown.

METHODS AND RESULTS

We used Medicare inpatient files to identify index admissions for PCI and CABG from 2013 through 2016 at BPCI hospitals and matched control hospitals and difference in differences models to compare the 2 groups. Our primary outcome was the change in standardized Medicare-allowed payments per 90-day episode. Secondary outcomes included changes in patient selection, discharge to postacute care, length of stay, emergency department use, readmissions, and mortality. Forty-two hospitals joined BPCI for PCI and 46 for CABG. There were no differential changes in patient selection between BPCI and control hospitals. Baseline Medicare payments per episode for PCI were $20 164 at BPCI hospitals and $19 955 at control hospitals. For PCI, payments increased at both BPCI and control hospitals during the intervention period, such that there was no significant difference in differences (BPCI hospitals +$673, =0.048; control hospitals +$551, =0.022; difference in differences $122, =0.768). For CABG, payments at both BPCI and control hospitals decreased during the intervention period (BPCI baseline, $36 925, change -$2918, <0.001; control baseline, $36 877, change -$2618, <0.001; difference in differences, $300; =0.730). For both PCI and CABG, BPCI participation was not associated with changes in mortality, readmissions, or length of stay. Among BPCI hospitals, emergency department use differentially increased for patients undergoing PCI and decreased for patients undergoing CABG.

CONCLUSIONS

Participation in episode-based payment for PCI and CABG was not associated with changes in patient selection, payments, length of stay, or clinical outcomes.

摘要

背景

医疗保险和医疗补助服务中心于 2013 年推出了医保捆绑支付计划（BPCI）。其对经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的支付和结果的影响尚不清楚。

方法和结果

我们使用医疗保险住院档案，从 2013 年到 2016 年，在 BPCI 医院和匹配的对照医院中识别出 PCI 和 CABG 的入院指数，并使用差异中的差异模型进行比较。我们的主要结果是每 90 天发生的标准化医疗保险允许支付的变化。次要结果包括患者选择、出院至康复护理、住院时间、急诊使用、再入院和死亡率的变化。42 家医院加入了 PCI 的 BPCI，46 家医院加入了 CABG 的 BPCI。BPCI 和对照医院之间在患者选择方面没有差异变化。PCI 的 BPCI 医院每例的基线医疗保险支付额为 20164 美元，对照医院为 19955 美元。对于 PCI，在干预期间，BPCI 和对照医院的支付都有所增加，因此差异无统计学意义（BPCI 医院增加$673，=0.048；对照医院增加$551，=0.022；差异为$122，=0.768）。对于 CABG，在干预期间，BPCI 和对照医院的支付都减少了（BPCI 基线，$36925，减少$-2918，<0.001；对照基线，$36877，减少$-2618，<0.001；差异为$300，=0.730）。对于 PCI 和 CABG，BPCI 的参与与死亡率、再入院率或住院时间的变化无关。在 BPCI 医院中，接受 PCI 的患者的急诊使用率差异增加，而接受 CABG 的患者的急诊使用率差异减少。