Karen E. Joynt Maddox (
E. John Orav, Harvard University and Brigham and Women's Hospital, Boston, Massachusetts.
Health Aff (Millwood). 2022 Nov;41(11):1661-1669. doi: 10.1377/hlthaff.2022.00138.
Medicare's Bundled Payments for Care Improvement Advanced Model (BPCI-A) is a voluntary Alternative Payment Model in which participating hospitals are held accountable for ninety-day episodes of care. To meet spending targets, hospitals must either decrease utilization or attract a less sick patient population; this could lead to the elimination of necessary care or avoidance of patients with medical or social vulnerability. We used publicly available data on BPCI-A participation, along with Medicare claims from the period 2017-19, to examine patient selection, changes in Medicare payment, and key clinical outcomes among three groups: patients with frailty, patients with multimorbidity, and patients with dual enrollment (both Medicare and Medicaid). We found no consistent change in patient selection associated with BPCI-A participation. Patients with frailty, multimorbidity, or dual enrollment were more expensive at baseline, but Medicare payments decreased similarly in these groups compared with lower-risk patients. There were no differential negative changes in clinical outcomes between BPCI-A participants and nonparticipants among patients with medical or social vulnerability.
医疗保险的捆绑支付改善高级模式（BPCI-A）是一种自愿的替代支付模式，参与的医院对 90 天的护理期负责。为了达到支出目标，医院必须要么减少利用率，要么吸引病情较轻的患者群体；这可能导致必要的护理被取消或避免医疗或社会弱势的患者。我们使用了公开的 BPCI-A 参与数据，以及 2017-19 年期间的医疗保险索赔数据，来检查三个组别的患者选择、医疗保险支付的变化以及关键临床结果：体弱患者、多病患者和双重入组（医疗保险和医疗补助）患者。我们没有发现与 BPCI-A 参与相关的患者选择的一致变化。在基线时，体弱、多病或双重入组的患者费用更高，但与低风险患者相比，这些患者的医疗保险支付下降幅度相似。在有医疗或社会弱势的患者中，BPCI-A 参与者和非参与者之间的临床结果没有差异的负面变化。
