Savings and outcomes under Medicare's bundled payments initiative for skilled nursing facilities.
Aged
Aged, 80 and over
Case-Control Studies
Diagnosis-Related Groups
/ economics
Episode of Care
Female
Health Expenditures
/ statistics & numerical data
Humans
Interrupted Time Series Analysis
Male
Medicare
/ statistics & numerical data
Outcome Assessment, Health Care
Patient Care Bundles
/ economics
Reimbursement Mechanisms
Retrospective Studies
Skilled Nursing Facilities
/ economics
United States
Medicare
dementia
frailty
payment models
skilled nursing facilities
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
08
07
2021
received:
09
04
2021
accepted:
19
07
2021
pubmed:
12
8
2021
medline:
22
12
2021
entrez:
11
8
2021
Statut:
ppublish
Résumé
Model 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown. Retrospective cohort study using Medicare claims from 2012 to 2017. We used an interrupted time-series design to compare participating vs matched control SNFs on total 90-day Medicare payments and payment components (initial SNF stay, readmissions, and outpatient/clinician), case mix (volume, proportion Medicaid, proportion black, number of comorbidities), and clinical outcomes (90-day readmission, mortality and healthy days at home, and length of initial SNF stay), overall and among key subgroups with frailty or dementia, for 47 of the 48 conditions in the program (excluding major lower extremity joint replacement). Our sample included 1001 participating and 3873 matched control SNFs. At baseline, total Medicare institutional payments were increasing at BPCI SNFs at a rate of $121 per episode per quarter; during the intervention period, payments decreased at a rate of -$398/episode/quarter. Among controls, payments were stable in the baseline period (+$17/episode/quarter) but decreased at -$424/episode/quarter during the intervention period, yielding a nonsignificant difference in slope changes of -$79/episode/quarter (95% confidence interval [CI] -$188, $31, p = 0.16). However, among patients with frailty, spending declined by $620/episode/quarter in the BPCI group, compared with $330/episode/quarter in the non-BPCI group, for a difference in slope changes of -$289 (95% CI -$482, -$96, p = 0.003). There were no differences in the change in slopes in case selection or clinical outcomes overall or in any clinical subgroup. SNF participation in BPCI was associated with no overall differential change in total Medicare payments per episode, case selection, or clinical outcomes. Exploratory analyses revealed a decrease in Medicare payments in patients with frailty that may warrant further study.
Sections du résumé
BACKGROUND
Model 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown.
METHODS
Retrospective cohort study using Medicare claims from 2012 to 2017. We used an interrupted time-series design to compare participating vs matched control SNFs on total 90-day Medicare payments and payment components (initial SNF stay, readmissions, and outpatient/clinician), case mix (volume, proportion Medicaid, proportion black, number of comorbidities), and clinical outcomes (90-day readmission, mortality and healthy days at home, and length of initial SNF stay), overall and among key subgroups with frailty or dementia, for 47 of the 48 conditions in the program (excluding major lower extremity joint replacement).
RESULTS
Our sample included 1001 participating and 3873 matched control SNFs. At baseline, total Medicare institutional payments were increasing at BPCI SNFs at a rate of $121 per episode per quarter; during the intervention period, payments decreased at a rate of -$398/episode/quarter. Among controls, payments were stable in the baseline period (+$17/episode/quarter) but decreased at -$424/episode/quarter during the intervention period, yielding a nonsignificant difference in slope changes of -$79/episode/quarter (95% confidence interval [CI] -$188, $31, p = 0.16). However, among patients with frailty, spending declined by $620/episode/quarter in the BPCI group, compared with $330/episode/quarter in the non-BPCI group, for a difference in slope changes of -$289 (95% CI -$482, -$96, p = 0.003). There were no differences in the change in slopes in case selection or clinical outcomes overall or in any clinical subgroup.
CONCLUSIONS
SNF participation in BPCI was associated with no overall differential change in total Medicare payments per episode, case selection, or clinical outcomes. Exploratory analyses revealed a decrease in Medicare payments in patients with frailty that may warrant further study.
Identifiants
pubmed: 34379323
doi: 10.1111/jgs.17409
pmc: PMC8649071
mid: NIHMS1729186
doi:
Types de publication
Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3422-3434Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL143421
Pays : United States
Organisme : NIA NIH HHS
ID : R21 AG065526
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG063759
Pays : United States
Organisme : NIA NIH HHS
ID : K23 AG058806
Pays : United States
Organisme : NIA NIH HHS
ID : R01AG060935
Pays : United States
Organisme : NIA NIH HHS
ID : K23AG058806
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG060935
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The American Geriatrics Society.
Références
Pharm Stat. 2011 Mar-Apr;10(2):150-61
pubmed: 20925139
Am J Accountable Care. 2017 Mar;5(1):16-22
pubmed: 29152607
BMJ. 2020 Jun 17;369:m1780
pubmed: 32554705
J Arthroplasty. 2016 Feb;31(2):343-50
pubmed: 26427938
Health Serv Res. 2018 Dec;53(6):4138-4156
pubmed: 29957834
JAMA Intern Med. 2019 May 1;179(5):617-623
pubmed: 30855652
JAMA Intern Med. 2017 Feb 1;177(2):214-222
pubmed: 28055062
JAMA. 2016 Sep 27;316(12):1267-78
pubmed: 27653006
N Engl J Med. 2018 Jul 19;379(3):260-269
pubmed: 30021090
Healthc (Amst). 2020 Mar;8(1):100378
pubmed: 31708403
Ann Am Thorac Soc. 2017 May;14(5):643-648
pubmed: 28005410
J Gerontol A Biol Sci Med Sci. 2018 Jun 14;73(7):980-987
pubmed: 29244057
J Am Geriatr Soc. 2020 Apr;68(4):826-834
pubmed: 31850532
J Am Geriatr Soc. 2019 May;67(5):1027-1035
pubmed: 30802938
J Bone Joint Surg Am. 2016 Dec 7;98(23):1949-1953
pubmed: 27926675
JAMA. 2018 Apr 17;319(15):1616-1617
pubmed: 29677292
JAMA Netw Open. 2020 Jan 3;3(1):e1918738
pubmed: 31913495
J Am Med Dir Assoc. 2020 Apr;21(4):545-549.e1
pubmed: 32241567
Health Aff (Millwood). 2019 Jul;38(7):1127-1131
pubmed: 31260343
N Engl J Med. 2019 Jul 25;381(4):302-303
pubmed: 31340092
JAMA. 2020 Nov 10;324(18):1869-1877
pubmed: 33170241
Med Care. 2020 Oct;58(10):895-902
pubmed: 32833936
Health Aff (Millwood). 2020 Jan;39(1):58-66
pubmed: 31905062