Unbiased Analysis of Today's Healthcare Issues

Did BPCI work?

Written By: Jason Shafrin - Oct• 02•16

BPCI is Medicare’s Bundled Payments for Care Improvement initiative.  For selected conditions, hospitals receive bundled payments that can include concurrent physician payments, post acute-care or other arrangements.

The question is, does this payment approach improve quality and reduce cost? A study by Dummit et al. (2016) looked at lower extremity joint replacement at a BPCI-participating hospital.  They found the following:

The BPCI mean Medicare episode payments were $30 551 (95% CI, $30 201 to $30 901) in the baseline period and declined by $3286 to $27 265 (95% CI, $26 838 to $27 692) in the intervention period. The comparison mean Medicare episode payments were $30 057 (95% CI, $29 765 to $30 350) in the baseline period and declined by $2119 to $27 938 (95% CI, $27 639 to $28 237). The mean Medicare episode payments declined by an estimated $1166 more (95% CI, −$1634 to −$699; P < .001) for BPCI episodes than for comparison episodes, primarily due to reduced use of institutional postacute care. There were no statistical differences in the claims-based quality measures, which included 30-day unplanned readmissions (−0.1%; 95% CI, −0.6% to 0.4%), 90-day unplanned readmissions (−0.4%; 95% CI, −1.1% to 0.3%), 30-day emergency department visits (−0.1%; 95% CI, −0.7% to 0.5%), 90-day emergency department visits (0.2%; 95% CI, −0.6% to 1.0%), 30-day postdischarge mortality (−0.1%; 95% CI, −0.3% to 0.2%), and 90-day postdischarge mortality (−0.0%; 95% CI, −0.3% to 0.3%).

In short, bundled payments reduced cost but did not improve quality of care for Medicare patients receiving lower extremity joint replacement.

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