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.
Source:
- Dummit, L.A., Kahvecioglu, D., Marrufo, G., Rajkumar, R., Marshall, J., Tan, E., Press, M.J., Flood, S., Muldoon, L.D., Gu, Q. and Hassol, A., 2016. Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes. JAMA.