Effectiveness of a Bundled Payments for Care Improvement Program for Chronic Obstructive Pulmonary Disease.
bundled Payment Care Initiative
chronic obstructive pulmonary disease
medicare
quality of health care
readmissions
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
29
07
2022
accepted:
18
05
2023
pmc-release:
01
09
2024
medline:
19
9
2023
pubmed:
21
6
2023
entrez:
20
6
2023
Statut:
ppublish
Résumé
The Medicare Bundled Payments for Care Improvement (BPCI) program reimburses 90-day care episodes post-hospitalization. COPD is a leading cause of early readmissions making it a target for value-based payment reform. Evaluate the financial impact of a COPD BPCI program. A single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Mean episode costs and readmissions. Between October 2015 and September 2018, 132 received and 161 did not receive the program, respectively. Mean episode costs were below target for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 (95% CI: - $811 to $5795) in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG); there were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode was observed in 90-day readmission rates for intervention relative to control. Readmissions and hospital discharges to skilled nursing facilities were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively). Our COPD BPCI program had a non-significant cost-saving effect, although sample size limited study power. The differential impact of the intervention by DRG suggests that targeting interventions to more clinically complex patients could increase the financial impact of the program. Further evaluations are needed to determine if our BPCI program decreased care variation and improved quality of care. This research was supported by NIH NIA grant #5T35AG029795-12.
Sections du résumé
BACKGROUND
The Medicare Bundled Payments for Care Improvement (BPCI) program reimburses 90-day care episodes post-hospitalization. COPD is a leading cause of early readmissions making it a target for value-based payment reform.
OBJECTIVE
Evaluate the financial impact of a COPD BPCI program.
DESIGN, PARTICIPANTS, INTERVENTIONS
A single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention.
MAIN MEASURES
Mean episode costs and readmissions.
KEY RESULTS
Between October 2015 and September 2018, 132 received and 161 did not receive the program, respectively. Mean episode costs were below target for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 (95% CI: - $811 to $5795) in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG); there were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode was observed in 90-day readmission rates for intervention relative to control. Readmissions and hospital discharges to skilled nursing facilities were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
CONCLUSIONS
Our COPD BPCI program had a non-significant cost-saving effect, although sample size limited study power. The differential impact of the intervention by DRG suggests that targeting interventions to more clinically complex patients could increase the financial impact of the program. Further evaluations are needed to determine if our BPCI program decreased care variation and improved quality of care.
PRIMARY SOURCE OF FUNDING
This research was supported by NIH NIA grant #5T35AG029795-12.
Identifiants
pubmed: 37340256
doi: 10.1007/s11606-023-08249-6
pii: 10.1007/s11606-023-08249-6
pmc: PMC10506991
doi:
Types de publication
Observational Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2662-2670Subventions
Organisme : NIA NIH HHS
ID : T35 AG029795
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL146644
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS027804
Pays : United States
Informations de copyright
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.
Références
CDC - COPD Home Page - Chronic Obstructive Pulmonary Disease (COPD). Published January 29, 2019. Accessed July 9, 2019. https://www.cdc.gov/copd/index.html
Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, Benjamin EM. Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2006;144(12):894–903. doi: https://doi.org/10.7326/0003-4819-144-12-200606200-00006
doi: 10.7326/0003-4819-144-12-200606200-00006
pubmed: 16785478
Shah T, Press VG, Huisingh-Scheetz M, White SR. COPD Readmissions: Addressing COPD in the Era of Value-based Health Care. CHEST. 2016;150(4):916–926. doi: https://doi.org/10.1016/j.chest.2016.05.002
doi: 10.1016/j.chest.2016.05.002
pubmed: 27167208
pmcid: 5812767
Bhatt SP, Wells JM, Iyer AS, et al. Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions. Ann Am Thorac Soc. 2017;14(5):643–648. doi: https://doi.org/10.1513/AnnalsATS.201610-775BC
doi: 10.1513/AnnalsATS.201610-775BC
pubmed: 28005410
pmcid: 5802596
CMS. Hospital Readmissions Reduction Program. Published January 16, 2019. Accessed April 16, 2019 https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html
CMS. Bundled Payments for Care Improvement (BPCI) Initiative: General Information | Center for Medicare & Medicaid Innovation. Accessed April 15, 2019 https://innovation.cms.gov/initiatives/bundled-payments/
Press VG, Au DH, Bourbeau J, et al. Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2019;16(2):161–170. doi: https://doi.org/10.1513/AnnalsATS.201811-755WS
doi: 10.1513/AnnalsATS.201811-755WS
CMS. BPCI Model 2: Retrospective Acute & Post Acute Care Episode. CMS Innovation Center. Accessed October 27, 2020 https://innovation.cms.gov/innovation-models/bpci-model-2
P Lindenauer, Au D, Chang W, LaBrin J, Mularski R, Press V. COPD Implementation Guide. Accessed December 19, 2020 https://www.hospitalmedicine.org/globalassets/clinical-topics/clinical-pdf/shm_chronic_obstructive_pulmonary_disease_program_guide.pdf
2021 GOLD Reports. Global Initiative for Chronic Obstructive Lung Disease - GOLD. Accessed March 14, 2021 https://goldcopd.org/2021-gold-reports/
Mueller SK, Sponsler KC, Kripalani S, Schnipper JL. Hospital-Based Medication Reconciliation Practices: A Systematic Review. Arch Intern Med. 2012;172(14):1057–1069. doi: https://doi.org/10.1001/archinternmed.2012.2246
doi: 10.1001/archinternmed.2012.2246
pubmed: 22733210
pmcid: 3575731
Mueller SK, Kripalani S, Stein J, et al. A Toolkit to Disseminate Best Practices in Inpatient Medication Reconciliation: Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). Jt Comm J Qual Patient Saf. 2013;39 (8) AP1-AP3 https://doi.org/10.1016/S1553-7250(13)39051-5
Paasche-Orlow MK, Riekert KA, Bilderback A, et al. Tailored Education May Reduce Health Literacy Disparities in Asthma Self-Management. Am J Respir Crit Care Med. 2005;172(8):980–986. doi: https://doi.org/10.1164/rccm.200409-1291OC
doi: 10.1164/rccm.200409-1291OC
pubmed: 16081544
pmcid: 2718412
Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. 2011;26(6):635-642. doi: https://doi.org/10.1007/s11606-010-1624-2
doi: 10.1007/s11606-010-1624-2
pubmed: 21249463
pmcid: 3101982
Press VG, Arora VM, Trela KC, et al. Effectiveness of Interventions to Teach Metered-Dose and Diskus Inhaler Techniques. A Randomized Trial. Ann Am Thorac Soc. 2016;13(6):816–824. doi: https://doi.org/10.1513/AnnalsATS.201509-603OC
doi: 10.1513/AnnalsATS.201509-603OC
pubmed: 26998961
pmcid: 5018923
Lash DB, Mack A, Jolliff J, Plunkett J, Joson JL. Meds-to-Beds: The impact of a bedside medication delivery program on 30-day readmissions. JACCP J Am Coll Clin Pharm. 2019;2(6):674–680. doi:https://doi.org/ https://doi.org/10.1002/jac5.1108
doi: 10.1002/jac5.1108
Zillich AJ, Jaynes HA, Davis HB, et al. Evaluation of a “Meds-to-Beds” program on 30-day hospital readmissions. JACCP J Am Coll Clin Pharm. 2020;3(3):577–585. doi:https://doi.org/ https://doi.org/10.1002/jac5.1183
doi: 10.1002/jac5.1183
Feemster LC, Au DH. Penalizing hospitals for chronic obstructive pulmonary disease readmissions. Am J Respir Crit Care Med. 2014;189(6):634–639. doi: https://doi.org/10.1164/rccm.201308-1541PP
doi: 10.1164/rccm.201308-1541PP
pubmed: 24460431
pmcid: 3983837
Diagnosis Related Group (DRG). Accessed August 16, 2019. https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm
CMS. BPCI Advanced. CMS Innovation Center. https://innovation.cms.gov/innovation-models/bpci-advanced
Desgagné A, Castilloux AM, Angers JF, Le Lorier J. The Use of the Bootstrap Statistical Method for the Pharmacoeconomic Cost Analysis of Skewed Data. PharmacoEconomics. 1998;13(5):487–497. doi: https://doi.org/10.2165/00019053-199813050-00002
doi: 10.2165/00019053-199813050-00002
pubmed: 10180748
Press VG. Is It Time to Move on from Identifying Risk Factors for 30-Day Chronic Obstructive Pulmonary Disease Readmission? A Call for Risk Prediction Tools. Ann Am Thorac Soc. 2018;15(7):801–803. doi: https://doi.org/10.1513/AnnalsATS.201804-246ED
doi: 10.1513/AnnalsATS.201804-246ED
pubmed: 29957037
Press VG, Myers LC, Feemster LC. Preventing COPD Readmissions Under the Hospital Readmissions Reduction Program How Far Have We Come? Chest. 2021 Mar;159(3): 996–1006. doi: https://doi.org/10.1016/j.chest.2020.10.008
Rinne ST, Press VG. Moving the Bar on Chronic Obstructive Pulmonary Disease Readmissions before and after the Hospital Readmission Reduction Program: Myth or Reality? Ann Am Thorac Soc. 2020;17(4):423–425. doi: https://doi.org/10.1513/AnnalsATS.202001-010ED
doi: 10.1513/AnnalsATS.202001-010ED
pubmed: 32233856
Press VG, Miller BJ. The Hospital Readmissions Reduction Program and COPD: More Answers, More Questions. J Hosp Med. 2020;15(4):252–253. doi: https://doi.org/10.12788/jhm.3362
doi: 10.12788/jhm.3362
pubmed: 32118570
van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ Can Med Assoc J J Assoc Medicale Can. 2011;183(7):E391–402. doi: https://doi.org/10.1503/cmaj.101860
doi: 10.1503/cmaj.101860
Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding Why Patients With COPD Get Readmitted: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion. Chest. 2015;147(5):1219–1226. doi: https://doi.org/10.1378/chest.14-2181
doi: 10.1378/chest.14-2181
pubmed: 25539483
Joynt KE, Jha AK. Thirty-Day Readmissions — Truth and Consequences. N Engl J Med. 2012;366(15):1366–1369. doi: https://doi.org/10.1056/NEJMp1201598
doi: 10.1056/NEJMp1201598
pubmed: 22455752
Joynt KE, Jha AK. Characteristics of Hospitals Receiving Penalties Under the Hospital Readmissions Reduction Program. JAMA. 2013;309(4):342–343. doi: https://doi.org/10.1001/jama.2012.94856
doi: 10.1001/jama.2012.94856
pubmed: 23340629
Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff Proj Hope. 2014;33(5):778–785. doi: https://doi.org/10.1377/hlthaff.2013.0816
doi: 10.1377/hlthaff.2013.0816
Press VG, Konetzka RT, White SR. Insights about the economic impact of chronic obstructive pulmonary disease readmissions post implementation of the hospital readmission reduction program. Curr Opin Pulm Med. 2018;24(2):138–146. doi: https://doi.org/10.1097/MCP.0000000000000454
doi: 10.1097/MCP.0000000000000454
pubmed: 29210750
pmcid: 5810972
Joynt Maddox KE, Orav EJ, Zheng J, Epstein AM. Evaluation of Medicare’s Bundled Payments Initiative for Medical Conditions. N Engl J Med. 2018;379(3):260–269. doi: https://doi.org/10.1056/NEJMsa1801569
doi: 10.1056/NEJMsa1801569
pubmed: 30021090
Rojas JC, Chokkara S, Zhu M, Lindenauer PK, Press VG. Care Quality for Patients with Chronic Obstructive Pulmonary Disease in the Readmission Penalty Era. Am J Respir Crit Care Med. 2023 Jan 1;207(1):29–37. doi: https://doi.org/10.1164/rccm.202203-0496OC .
doi: 10.1164/rccm.202203-0496OC
pubmed: 35916652
Aboumatar H, Naqibuddin M, Chung S, et al. Effect of a Hospital-Initiated Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Patients Hospitalized With Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. JAMA. 2019;322(14):1371–1380. doi: https://doi.org/10.1001/jama.2019.11982
doi: 10.1001/jama.2019.11982
pubmed: 31593271
pmcid: 6784754