OrthoCarolina Hip and Knee Centre, Charlotte, North Carolina, USA.
Orthopaedic Surgery, Atrium Musculoskeletal Institute, Charlotte, North Carolina, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):119-125. doi: 10.1302/0301-620X.103B6.BJJ-2020-2315.R1.
There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service.
Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). With rebasing of Target Prices in 2020 and opportunity for participants to drop out, we compared retention rates of hospitals and physician groups enrolled at the onset of BPCI Advanced with current enrolment in 2020.
At its peak in July 2015, 342 acute care hospitals and physician groups participated in Lower Extremity Joint Replacement (LEJR) in BPCI Classic. At its peak in March 2019, 534 acute care hospitals and physician groups participated in LEJR in BPCI Advanced. In January 2020, only 14.5% of legacy hospitals and physician groups opted to stay in BPCI Advanced for LEJR. Analysis of Target Price factors by legacy hospitals during both programmes demonstrates that participants in BPCI Classic received larger negative adjustments on the Target Price than non-legacy hospitals.
BPCI Advanced provides little opportunity for a reduction in cost to offset a reduced Target Price for efficient providers, as made evident by the 85.5% withdrawal rate for BPCI Advanced. Efficient providers in BPCI Advanced are challenged by the programme's application of trend and efficiency factors that presumes their cost reduction can continue to decline at the same rate as non-efficient providers. It remains to be seen if reverting back to Medicare fee for service will support the same level of care and quality achieved in historical bundled payment programmes. Cite this article: 2021;103-B(6 Supple A):119-125.
有人担心，新捆绑支付改善高级计划（BPCI-A）中的激进目标定价会惩罚那些通过捆绑支付先前经验实现低成本的绩效较高的团体。我们假设这种方法包含了目标价格的不可持续下降趋势，这将导致团体选择退出 BPCI 高级计划，转而选择传统的按服务收费方式。
使用医疗保险和医疗补助服务中心（CMS）的数据，我们比较了同时参与 BPCI 经典版和 BPCI 高级版（传统组）的医院和医师组与仅参与 BPCI 高级版（非传统组）的目标价格因素。由于 2020 年目标价格重新调整以及参与者退出的机会，我们比较了 2020 年 BPCI 高级计划开始时入组的医院和医师组的保留率与当前入组率。
在 2015 年 7 月达到顶峰时，342 家急性护理医院和医师组参与了 BPCI 经典版的下肢关节置换术（LEJR）。在 2019 年 3 月达到顶峰时，534 家急性护理医院和医师组参与了 BPCI 高级版的 LEJR。2020 年 1 月，只有 14.5%的传统医院和医师组选择继续留在 BPCI 高级版的 LEJR。对两个项目中传统医院的目标价格因素进行分析表明，参与 BPCI 经典版的医院比非传统医院的目标价格受到更大的负面调整。
BPCI 高级版为高效提供者提供了减少成本以抵消目标价格降低的机会很小，这从 BPCI 高级版 85.5%的退出率就可以明显看出。BPCI 高级版中的计划应用趋势和效率因素对高效提供者构成了挑战，因为这些因素假设他们的成本降低可以继续以与非高效提供者相同的速度下降。如果恢复到 Medicare 按服务收费，是否会支持在历史捆绑支付计划中实现的相同水平的护理和质量，还有待观察。
