Year 1 of the Bundled Payments for Care Improvement-Advanced Model.
Year 1 of the Bundled Payments for Care Improvement-Advanced Model.
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DOI：
10.1056/nejmsa2033678
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发表时间：
2021-08-12
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影响因子：
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通讯作者：
Epstein AM
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作者：
Joynt Maddox KE;Orav EJ;Zheng J;Epstein AM
医疗保险和医疗补助创新中心于2018年10月为医院推出了医疗保险捆绑支付护理高级（BPCI-A）计划。需要有关该计划对医疗保健利用和医疗保险支付的影响的信息。我们使用医疗保险索赔进行了修改的分段回归分析，包括出院日期为2017年1月至2019年9月的患者，以评估BPCI-A参与者和两个对照组之间的差异：从未加入BPCI-A计划的医院（非加入医院）和2020年1月加入BPCI-A计划的医院，在干预期结束后（后加入的医院）。主要结果是90天每次发作医疗保险支付的季度趋势变化差异和出院后90天内再次入院的患者百分比。次要结局为死亡率、数量和病例组合。共有826家BPCI-A参与医院与2016家未加入医院和334家晚加入医院进行了比较。在BPCI-A医院中，平均基线90天每次发作的医疗保险支付为27，315美元;与基线相比，干预期间的季度趋势变化为-78美元/季度。在未加入的医院中，平均基线90天每次发作的医疗保险支付为25，994美元;与基线相比，季度趋势变化为每季度-26美元（未加入的医院和BPCI-A医院之间的差异为每季度52美元[95%置信区间{CI}，34 - 70]; P<0.001;基线支付的0.2%）。在晚加入的医院中，平均基线90天每次发作的医疗保险支付为26，807美元;与基线相比，季度趋势的变化为每季度4美元（晚加入的医院和BPCI-A医院之间的差异为每季度82美元[95%CI，41至122]; P<0.001;基线支付的0.3%）。在再入院率、死亡率、数量或病例组合方面的变化没有有意义的差异。与对照医院相比，BPCI-A计划与参与医院的医疗保险支付的小幅减少有关。（由国家心脏，肺和血液研究所资助。
The Center for Medicare and Medicaid Innovation launched the Medicare Bundled Payments for Care Improvement–Advanced (BPCI-A) program for hospitals in October 2018. Information is needed about the effects of the program on health care utilization and Medicare payments. We conducted a modified segmented regression analysis using Medicare claims and including patients with discharge dates from January 2017 through September 2019 to assess differences between BPCI-A participants and two control groups: hospitals that never joined the BPCI-A program (nonjoining hospitals) and hospitals that joined the BPCI-A program in January 2020, after the conclusion of the intervention period (late-joining hospitals). The primary outcomes were the differences in changes in quarterly trends in 90-day per-episode Medicare payments and the percentage of patients with readmission within 90 days after discharge. Secondary outcomes were mortality, volume, and case mix. A total of 826 BPCI-A participant hospitals were compared with 2016 nonjoining hospitals and 334 late-joining hospitals. Among BPCI-A hospitals, the mean baseline 90-day per-episode Medicare payment was $27,315; the change in the quarterly trends in the intervention period as compared with baseline was −$78 per quarter. Among nonjoining hospitals, the mean baseline 90-day per-episode Medicare payment was $25,994; the change in quarterly trends as compared with baseline was −$26 per quarter (difference between nonjoining hospitals and BPCI-A hospitals, $52 [95% confidence interval {CI}, 34 to 70] per quarter; P<0.001; 0.2% of the baseline payment). Among late-joining hospitals, the mean baseline 90-day per-episode Medicare payment was $26,807; the change in the quarterly trends as compared with baseline was $4 per quarter (difference between late-joining hospitals and BPCI-A hospitals, $82 [95% CI, 41 to 122] per quarter; P<0.001; 0.3% of the baseline payment). There were no meaningful differences in the changes with regard to readmission, mortality, volume, or case mix. The BPCI-A program was associated with small reductions in Medicare payments among participating hospitals as compared with control hospitals. (Funded by the National Heart, Lung, and Blood Institute.)