Association of Physician Group Practice Participation in Bundled Payments With Patient Selection, Costs, and Outcomes for Joint Replacement.
Association of Physician Group Practice Participation in Bundled Payments With Patient Selection, Costs, and Outcomes for Joint Replacement.
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DOI：
10.1001/jamahealthforum.2021.0295
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Epstein AM
中科院分区：
文献类型：
--
作者：
Joynt Maddox KE;Orav EJ;Zheng J;Epstein AM
本横断面研究评估了医生群体参与医疗保险捆绑支付是否与成本或患者预后的变化有关。医师团体实践中参与护理改善捆绑支付（BPCI）计划是否与医疗保险支付、患者选择或临床结果的变化有关？在这项针对BPCI模型2中的91个骨科组和169个倾向匹配对照组的横断面研究中，BPCI参与组在干预期间将90天的医疗保险支付从18 257美元减少到15 320美元，而对照组的支付从17 927美元减少到16 170美元；与对照组相比，BPCI组30天和90天再入院率下降更多，90天在家健康天数增加。参与BPCI关节置换术的团体实践与减少医疗保险支付和改善临床结果相关。医疗保险的护理改善捆绑支付（BPCI）计划从2013年持续到2018年，是一项以医生为中心的替代支付模式的重要实验。然而，很少有人知道该计划是否与更好的质量或结果或更低的成本有关。目的：确定在医师组实践中参与BPCI是否与成本或患者预后的有利或有害变化相关。本横断面研究使用2013年至2017年的医疗保险档案和差异中的差异（DID）模型，比较了BPCI模型2中91个骨科组和169个倾向匹配对照组中接受关节置换术患者的医疗保险支付、患者选择和临床结果随时间的变化。分析在2019年12月至2021年2月期间进行。自愿参加BPCI。主要结果是90天的医疗保险支付；次要结局是患者选择（数量、合并症）和临床结局（30天和90天急诊科就诊、再入院、死亡率和在家健康天数）。基线期有74 343例患者发作，BPCI干预期间有102 790例；基线期有88 147例患者发作，对照组干预期间有120 253例患者发作；461 598例患者中女性291 214例（63.1%），白人419 619例（90.9%）。基线时，bpci组的平均支付额为18 257美元，干预期间降至15 320美元，而对照组从17 927美元降至16 170美元（DID， - 1180美元；95% CI， - 1565美元至- 795美元；P < .001）。急症后护理支出的减少推动了储蓄。在体积或合并症方面没有差异变化。与对照组相比，BPCI实践增加了出院回家的患者比例（23.6%至43.4% vs 22.2%至31.8%；DID, 10.2% [95% CI， 6.2%至14.1%]）。30天或90天死亡率或急诊就诊没有差异变化，但BPCI组30天和90天再入院率比对照组下降更多（90天：8.7%至7.5% vs 8.9%至8.7%；DID, - 1.0% [95% CI, - 1.4%至- 0.5%]），90天健康在家天数增加（BPCI， 82.9至84.8，对照组，83.1至84.4；DID, 0.6 [95% CI， 0.4至0.8]）。参与BPCI关节置换术的团体实践与减少医疗保险支付和改善临床结果相关。
This cross-sectional study assesses whether physician group participation in Medicare bundled payments is associated with changes in costs or patient outcomes. Was participation in the Bundled Payments for Care Improvement (BPCI) initiative among physician group practices associated with changes in Medicare payments, patient selection, or clinical outcomes? In this cross-sectional study of 91 orthopedic groups in BPCI Model 2 and 169 propensity-matched controls, BPCI-participating practices decreased 90-day Medicare payments from $18 257 to $15 320 during the intervention, while control practices decreased payments from $17 927 to $16 170; 30-day and 90-day readmission rates decreased more among BPCI practices than controls, and 90-day healthy days at home increased. Group practice participation in BPCI for joint replacement was associated with reduced Medicare payments and improvements in clinical outcomes. Medicare’s Bundled Payments for Care Improvement (BPCI) program, which ran from 2013 to 2018, was an important experiment in physician-focused alternative payment models. However, little is known about whether the program was associated with better quality or outcomes or lower costs. To determine whether participation in BPCI among physician group practices was associated with advantageous or deleterious changes in costs or patient outcomes. This cross-sectional study used 2013 to 2017 Medicare files and difference-in-differences (DID) models to compare the change over time in Medicare payments, patient selection, and clinical outcomes between 91 orthopedic groups in BPCI Model 2 and 169 propensity-matched controls for patients undergoing joint replacement. Analyses were performed between December 2019 and February 2021. Voluntary participation in BPCI. The primary outcome was 90-day Medicare payments; secondary outcomes were patient selection (volume, comorbidities) and clinical outcomes (30-day and 90-day emergency department visits, readmissions, mortality, and healthy days at home). There were 74 343 patient episodes in the baseline period and 102 790 during the intervention in BPCI practices, and 88 147 patient episodes in the baseline period and 120 253 during the intervention in control practices; 291 214 of 461 598 (63.1%) patients were women, and 419 619 (90.9%) were White. At baseline, mean episode payments among BPCI-participating practices were $18 257, which decreased to $15 320 during the intervention, while control practices decreased from $17 927 to $16 170 (DID, −$1180; 95% CI, −$1565 to −$795; P < .001). Savings were driven by a decrease in postacute care spending. There were no differential changes in volume or comorbidities. The BPCI practices increased the proportion of patients discharged home compared with controls (23.6% to 43.4% vs 22.2% to 31.8%; DID, 10.2% [95% CI, 6.2% to 14.1%]). There were no differential changes in 30-day or 90-day mortality rates or emergency department visits, but 30-day and 90-day readmission rates decreased more among BPCI practices than controls (90 days: 8.7% to 7.5% vs 8.9% to 8.7%; DID, −1.0% [95% CI, −1.4% to −0.5%]), and 90-day healthy days at home increased (BPCI, 82.9 to 84.8, vs controls, 83.1 to 84.4; DID, 0.6 [95% CI, 0.4 to 0.8]). Group practice participation in BPCI for joint replacement was associated with reduced Medicare payments and improvements in clinical outcomes.
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影响因子：
120.7
作者：
Barnett, Michael L.;Joynt Maddox, Karen E.;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
5.3
作者：
Dundon, John M.;Bosco, Joseph;Iorio, Richard
通讯作者：
Iorio, Richard
影响因子：
3.5
作者：
Iorio, Richard;Clair, Andrew J.;Zuckerman, Joseph D.
通讯作者：
Zuckerman, Joseph D.
在Medicare共享储蓄计划3年后，Medicare支出。
DOI：
10.1056/nejmsa1803388
发表时间：
2018-09-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
McWilliams JM;Hatfield LA;Landon BE;Hamed P;Chernew ME
通讯作者：
Chernew ME
影响因子：
39
作者：
Navathe, Amol S.;Troxel, Andrea B.;Emanuel, Ezekiel J.
通讯作者：
Emanuel, Ezekiel J.