Berlin Nicholas L, Gulseren Baris, Nuliyalu Ushapoorna, Ryan Andrew M
Nicholas L. Berlin is a National Clinician Scholar in the Institute for Healthcare Policy and Innovation at the University of Michigan, in Ann Arbor, Michigan.
Baris Gulseren is a health policy analyst in the Institute for Healthcare Policy and Innovation, University of Michigan.
Health Aff (Millwood). 2020 Sep;39(9):1479-1485. doi: 10.1377/hlthaff.2020.00104.
To reduce episode spending for twenty-nine predefined clinical conditions, the Centers for Medicare and Medicaid Services (CMS) implemented the voluntary Bundled Payments for Care Improvement (BPCI) Advanced Model program in 2018. Under this program, hospitals gain or lose revenue depending on their episode spending relative to target prices set by CMS. The relationship between target prices and hospital participation in BPCI Advanced is unknown, as are the financial implications for CMS. Using Medicare claims, we estimate that each $1,000 increase in target prices increased the probability of participation by 0.78 percentage points across all episodes. We then used Medicare claims before the start of BPCI Advanced to evaluate mean reversion, or the tendency for episode spending at individual hospitals to move closer to average episode spending over time, especially for hospitals having higher target prices. Hospitals with spending that was 10 percent more than target prices at baseline could expect spending to decline by 7.43 percent in the performance period, hospitals with spending that was 20 percent more saw spending decline by 9.80 percent, and hospitals with spending that was 30 percent more saw spending decline by 11.93 percent. Our findings suggest that CMS will end up paying substantial bonuses to hospitals that resulted from mean reversion rather than from meaningful reductions in costs.
为降低29种预定义临床病症的诊疗费用支出，医疗保险和医疗补助服务中心（CMS）于2018年实施了自愿性的改善护理捆绑支付（BPCI）高级模式项目。在该项目下，医院的收入增减取决于其诊疗费用支出与CMS设定的目标价格的对比情况。目标价格与医院参与BPCI高级模式之间的关系尚不清楚，CMS的财务影响也不明确。利用医疗保险理赔数据，我们估计，目标价格每提高1000美元，所有诊疗项目的参与概率就会提高0.78个百分点。然后，我们利用BPCI高级模式开始前的医疗保险理赔数据来评估均值回归情况，即个别医院的诊疗费用支出随时间推移向平均诊疗费用支出靠拢的趋势，尤其是对于目标价格较高的医院。基线时诊疗费用比目标价格高出10%的医院，预计在绩效期内诊疗费用将下降7.43%；高出20%的医院，诊疗费用下降9.80%；高出30%的医院，诊疗费用下降11.93%。我们的研究结果表明，CMS最终将向那些因均值回归而非成本有意义降低而受益的医院支付巨额奖金。
