09 Sep Medicare’s Bundled Payment Program–Does it Change Hospital Volume or Case Mix?
MedicalResearch.com Interview with:
Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
Penn Leonard Davis Institute of Health Economics
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients.
Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched.
The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.
MedicalResearch.com: What should readers take away from your report?
Response: We found that hospital participation in BPCI was not associated with changes in market-level LEJR volume and largely was not associated with changes in hospital case mix. These findings may provide reassurance regarding two potential unintended effects associated with bundled payments for LEJR.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research will be necessary to investigate the long-term effects of BPCI on market-level LEJR volume and case-mix. Moreover, it remains to be seen if our research findings are generalizable to other episodes, particularly medical bundles, or those initiated by physician groups. Finally, future research may explore the effects of mandatory bundled payments on volume changes and case-mix for mandatory bundled programs such as Medicare’s Comprehensive Care for Joint Replacement.
All disclosures are provided at the end of the JAMA article.
This research was supported by The Commonwealth Fund.
Navathe AS, Liao JM, Dykstra SE, et al. Association of Hospital Participation in a Medicare Bundled Payment Program With Volume and Case Mix of Lower Extremity Joint Replacement Episodes. JAMA.2018;320(9):901–910. doi:10.1001/jama.2018.12345
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