Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
School of Public Health, University of Michigan, Ann Arbor.
JAMA. 2022 Oct 25;328(16):1616-1623. doi: 10.1001/jama.2022.18529.
Bundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare & Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS.
To investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties.
DESIGN, SETTING, AND PARTICIPANTS: Difference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics.
BPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019).
Hospitals' per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital.
The study identified 694 participating hospitals. The analysis observed a -$175 change in mean per-episode spending (95% CI, -$378 to $28) and an aggregate spending change of -$75.1 million (95% CI, -$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups.
Among US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.
医保和医疗补助服务中心（CMS）的捆绑支付改善高级（BPCI-A）计划旨在通过激励临床支出减少来产生财务节省。激励措施包括 CMS 向医院提供的财务奖金或医院向 CMS 支付的罚款。
调查医院参与 BPCI-A 与支出的关联，并描述获得财务奖金和罚款的医院。
设计、地点和参与者：使用 2013-2019 年美国医疗保险索赔中 694 家参与和 2852 家非参与医院的 4754139 例患者病例的差异-差异和横截面分析，并与医院和市场特征合并。
BPCI-A 模型年 1 年和 2 年（2018 年 10 月 1 日至 2019 年 12 月 31 日）。
每家医院的每例费用、CMS 总费用和净费用以及分配给每家医院的激励。
本研究确定了 694 家参与医院。分析观察到每例费用的平均变化为-175 美元（95%CI，-378 至 28 美元），在 BPCI-A 模型年 1 年和 2 年的 428670 例中，总支出变化为-7510 万美元（95%CI，-1.621 亿美元至 1200 万美元）。然而，CMS 发放的奖金比收到的罚款多 3.543 亿美元（95%CI，2.120 亿美元至 4.960 亿美元）。医院参与 BPCI-A 与 CMS 净损失 2.792 亿美元（95%CI，1.350 亿美元至 4.230 亿美元）相关。 Medicaid 天数最低四分位数的医院平均罚款为 410 万美元（95%CI，90 万美元至 720 万美元），而最高四分位数的医院平均奖金为 1570 万美元（95%CI，1090 万美元至 2080 万美元）。在 Disproportionate Share Hospital 比例和少数族裔患者比例不断增加的医院中，也观察到了类似的模式。
在 2013 年至 2019 年期间测量的美国医院中，参与 BPCI-A 与 CMS 支出的净增加显著相关。奖金不成比例地流向为边缘化社区提供护理的医院。
