Impact of Medicare's Bundled Payments Initiative on Patient Selection, Payments, and Outcomes for Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting.
Impact of Medicare's Bundled Payments Initiative on Patient Selection, Payments, and Outcomes for Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting.
复制标题
DOI：
10.1161/circoutcomes.119.006171
复制
发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Joynt Maddox KE
中科院分区：
文献类型：
--
作者：
McNeely C;Orav EJ;Zheng J;Joynt Maddox KE
医疗保险和医疗补助创新中心（CMMI）于2013年推出了捆绑式医疗支付计划（BPCI）。它对经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的支付和结局的影响尚不清楚。我们使用医疗保险住院文件来确定2013年至2016年BPCI医院和匹配的对照医院的PCI和CABG的索引入院，并使用差异差异（DID）模型来比较两组。我们的主要结果是标准化医疗保险允许支付每90天的变化。次要结局包括患者选择的变化、出院到急性期后护理（PAC）、住院时间（LOS）、急诊科使用、再入院和死亡率。42家医院加入BPCI进行PCI，46家医院加入CABG。BPCI和对照医院之间的患者选择没有差异变化。在BPCI医院，PCI的基线医疗保险支付每集为20，164美元，对照医院为19，955美元。对于PCI，在干预期间，BPCI和对照医院的支付都增加了，因此没有显著差异（BPCI医院+673美元，p=0.048;对照医院+551美元，p=0.022; DID 122美元，p=0.768）。对于CABG，BPCI和对照医院的支付在干预期间均有所下降（BPCI基线，36，925美元，变化-2，918美元，p<0.001;对照基线，36，877美元，变化-2，618美元，p<0.001; DID，300美元; p=0.730）。对于PCI和CABG，BPCI参与与死亡率、再入院或LOS的变化无关。在BPCI医院中，接受PCI的患者的艾德使用差异性增加，接受CABG的患者的使用差异性减少。参与PCI和CABG的基于事件的支付与患者选择、支付、LOS或临床结局的变化无关。
The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Initiative (BPCI) in 2013. Its effect on payments and outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is unknown. We used Medicare inpatient files to identify index admissions for PCI and CABG from 2013 through 2016 at BPCI hospitals and matched control hospitals, and difference in differences (DID) models to compare the two groups. Our primary outcome was the change in standardized Medicare allowed payments per 90-day episode. Secondary outcomes included changes in patient selection, discharge to post-acute care (PAC), length of stay (LOS), emergency department use, readmissions, and mortality. 42 hospitals joined BPCI for PCI and 46 for CABG. There were no differential changes in patient selection between BPCI and control hospitals. Baseline Medicare payments per episode for PCI were $20,164 at BPCI hospitals, and $19,955 at control hospitals. For PCI, payments increased at both BPCI and control hospitals during the intervention period, such that there was no significant difference-in-difference (BPCI hospitals + $673, p=0.048; control hospitals + $551, p=0.022; DID $122, p=0.768). For CABG, payments at both BPCI and control hospitals decreased during the intervention period (BPCI baseline, $36,925, change −$2,918, p<0.001; control baseline, $36,877, change −$2,618, p<0.001; DID, $300; p=0.730). For both PCI and CABG, BPCI participation was not associated with changes in mortality, readmissions, or LOS. Among BPCI hospitals, ED use differentially increased for patients undergoing PCI and decreased for patients undergoing CABG. Participation in episode-based payment for PCI and CABG was not associated with changes in patient selection, payments, LOS, or clinical outcomes.