Nicholas L. Berlin is a National Clinician Scholar in the Institute for Healthcare Policy and Innovation, University of Michigan, in Ann Arbor, Michigan.
Timothy A. Peterson is the population health executive for Michigan Medicine and the ACO executive of the Physician Organization of Michigan Accountable Care Organization, in Ann Arbor, Michigan.
Health Aff (Millwood). 2021 Aug;40(8):1286-1293. doi: 10.1377/hlthaff.2020.01766.
The Bundled Payments for Care Improvement initiative Advanced Model (BPCI Advanced) is a voluntary Medicare bundled payment model in which hospitals may participate with third-party conveners-private consulting firms that share in the financial risk built into the program. We found that nonteaching and for-profit status was associated with a higher probability of hospital partnership with third-party conveners in BPCI Advanced. Among hospitals participating in at least one inpatient clinical episode, hospitals that partnered with third-party conveners were more likely to select episodes with higher target prices: A $1,000 increase in episode target price was associated with a 1.66-percentage-point increase in the probability of episode participation in BPCI Advanced compared with a 0.72-percentage-point increase for participating hospitals without third-party conveners. Hospitals with third-party conveners also were more likely than those without them to select inpatient clinical episodes with greater opportunities to reduce spending on postacute care and readmissions. These findings have important implications for understanding the role of private consulting firms in the program and for planning potential program modifications in the future.
支付方式改革试点项目（BPCI Advanced）是一项自愿参与的医疗保险捆绑支付模式，医院可以与第三方召集人（即共享该计划内金融风险的私营咨询公司）合作。我们发现，非教学医院和营利性医院与第三方召集人合作的可能性更高。在至少参与一个住院临床病例的医院中，与第三方召集人合作的医院更有可能选择目标价格较高的病例：与没有第三方召集人的参与医院相比，病例目标价格每增加 1000 美元，参与 BPCI Advanced 的概率就会增加 1.66 个百分点，而参与医院没有第三方召集人的则增加 0.72 个百分点。有第三方召集人的医院也比没有第三方召集人的医院更有可能选择具有更大降低急性后期护理和再入院费用机会的住院临床病例。这些发现对于理解私营咨询公司在该计划中的作用以及为未来计划修改提供了重要参考。
