Association of American Medical Colleges, 655 K St NW, Ste 100, Washington, DC, 20001, USA.
Healthc (Amst). 2023 Mar;11(1):100672. doi: 10.1016/j.hjdsi.2022.100672. Epub 2022 Dec 29.
In 2018, Medicare implemented a successor to its Bundled Payments for Care Improvement (BPCI) program, BPCI Advanced, with stricter participation rules and new financial incentives to reduce spending.
Using claims-based episode data from thirteen participants, we compared spending and utilization in the first fifteen months of the new program (October 2018 to December 2019) to hospital- and episode-specific target prices, with a deep dive into clinical correlates for the most commonly-selected clinical episodes, sepsis and congestive heart failure.
Twelve out of thirteen participants in a collaborative of teaching hospitals achieved shared savings for both Medicare and their own institution. Aggregate hospital shared savings were 5.8% of benchmark prices across 6,131 patients in 16 clinical episodes (p<0.001), appreciably higher than the reference savings rates reported after the first period of Medicare's predecessor BPCI program. Differences in shared savings across hospitals for sepsis and congestive heart failure correlated with reductions in patients' use of post-acute care, including reductions in skilled nursing facility, readmission, and home health rates. Evidence is presented showing reductions in patient utilization for cost-intensive post-acute settings accompanied increases in the proportion of patients exclusively utilizing non-institutional care after discharge from an anchor stay or procedure.
These findings provide an example of the fulfillment of a core promise of bundled payments to uncover new opportunities for reduced spending.
Non-random cohort of hospitals.
2018 年，医疗保险实施了其捆绑支付改善计划（BPCI）的继任者 BPCI 高级计划，该计划有更严格的参与规则和新的财务激励措施，以降低支出。
我们使用来自十三个参与者的基于索赔的病例数据，将新计划的前十五个月（2018 年 10 月至 2019 年 12 月）的支出和利用情况与医院和病例特定的目标价格进行比较，并深入研究了最常选择的临床病例（败血症和充血性心力衰竭）的临床相关性。
在一个教学医院的合作组织中，十三个参与者中的十二个实现了医疗保险和自己机构的共同节省。在 16 个临床病例的 6131 名患者中，医院共同节省了基准价格的 5.8%（p<0.001），明显高于 Medicare 前身 BPCI 计划第一个时期报告的参考节省率。败血症和充血性心力衰竭在医院之间的共同节省差异与患者接受急性后护理的使用减少相关，包括减少熟练护理设施、再入院和家庭健康率。有证据表明，在从锚定住院或手术出院后，患者对成本密集型急性后环境的利用减少，同时利用非机构护理的患者比例增加。
这些发现提供了捆绑支付兑现降低支出的新机会的核心承诺的一个例子。
非随机的医院队列。
