Association of Patient Outcomes With Bundled Payments Among Hospitalized Patients Attributed to Accountable Care Organizations.
Association of Patient Outcomes With Bundled Payments Among Hospitalized Patients Attributed to Accountable Care Organizations.
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DOI：
10.1001/jamahealthforum.2021.2131
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Werner RM
中科院分区：
文献类型：
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作者：
Navathe AS;Liao JM;Wang E;Isidro U;Zhu J;Cousins DS;Werner RM
与单独捆绑付款相比，在联邦医疗保险责任护理组织(ACO)和捆绑付款下同时接受护理是否与更好的患者结果相关？在这项对9名 850 080联邦医疗保险受益人的队列研究中，与仅包括在捆绑付款中相比，同时包括在ACO和捆绑付款中与机构急性后护理支出较低、因疾病发作而再次住院的人数以及仅因手术发作而再次住院的人数较少。这些发现表明，在ACOS等模式下接受护理可能会在捆绑支付下改善患者的预后。目前尚不清楚当患者同时接受捆绑付费和责任护理组织(ACO)计划的护理时，结果会受到什么影响。评估联邦医疗保险捆绑支付改善护理(BPCI)计划的结果是否根据患者是否归因于联邦医疗保险共享储蓄计划中的ACO而有所不同。这项队列研究使用了2011年1月1日至2016年9月30日的联邦医疗保险索赔数据，并进行了差异差异分析，以比较入住BPCI医院和非BPCI医院的患者的事件结局。对ACO患者和非ACO患者的预后进行了分层。参与者包括在美国医院接受内科和手术护理的联邦医疗保险按服务收费受益人。分析了2018年10月1日至2021年6月10日之间的数据。包括在BPCI中的48例(内科24例，外科24例)中的任何一例在参与这些事件的美国医院住院。主要结果是出院后90天机构支出的变化，次要结果包括质量和利用率的变化。共有7名 108146名受益人(平均年龄76.9[12.2]岁；4名 101081名妇女[58%])接受了内科护理，3名 675962名受益人(平均[SD]年龄74.8[10.1]岁；2名 074921名妇女[56%])接受了外科护理。与没有归因于ACO的患者相比，归因于ACO的患者中，捆绑付款和出院后机构支出变化之间的关联更大(-323美元差异；95%CI，-607美元至-39美元；P = .03)，但不是手术事件。归因于ACO也增加了内科发作(−0.98个百分点差；95%CI，-1.55比-0.41；P = .001)和手术发作(−0.84个百分点差；95%CI，−1.32比−0.35；P = .001)的捆绑付款与90天再住院变化之间的联系。在这项队列研究中，与单独包括在捆绑支付中相比，同时包括在ACOS和捆绑支付计划中与较低的机构急性后护理支出和医疗事件的再住院以及较低的再住院但不与手术事件的支出相关。在ACOS等模式下接受护理可能会在捆绑支付下改善事件结局。这项队列研究评估了与单独捆绑付款相比，同时纳入联邦医疗保险责任护理组织和捆绑付款计划是否与更好的患者结果相关。
Is receiving care simultaneously under a Medicare accountable care organization (ACO) and bundled payments associated with better patient outcomes compared with bundled payments alone? In this cohort study of 9 850 080 Medicare beneficiaries, simultaneous inclusion in both ACOs and bundled payments was associated with lower spending on institutional postacute care, fewer readmissions for medical episodes, and fewer readmissions only for surgical episodes compared with inclusion in bundled payments alone. These findings suggest that receiving care under models such as ACOs may improve patient outcomes under bundled payments. It is unknown how outcomes are affected when patients receive care under bundled payment and accountable care organization (ACO) programs simultaneously. To evaluate whether outcomes in the Medicare Bundled Payments for Care Improvement (BPCI) program differed depending on whether patients were attributed to ACOs in the Medicare Shared Savings Program. This cohort study was conducted using Medicare claims data from January 1, 2011, to September 30, 2016, and difference-in-differences analysis to compare episode outcomes for patients admitted to BPCI vs non-BPCI hospitals. Outcomes were stratified for patients who were and were not attributed to an ACO. Participants included Medicare fee-for-service beneficiaries receiving care for medical and surgical episodes at US hospitals. Data were analyzed between October 1, 2018, and June 10, 2021. Hospitalization for any of the 48 episodes (24 medical, 24 surgical) included in the BPCI at US hospitals participating in the BPCI for those episodes. The primary outcome was change in 90-day postdischarge institutional spending, and secondary outcomes included changes in quality and utilization. A total of 7 108 146 beneficiaries (mean [SD] age, 76.9 [12.2] years; 4 101 081 women [58%]) received care for medical episodes, and 3 675 962 beneficiaries (mean [SD] age, 74.8 [10.1] years; 2 074 921 women [56%]) received care for surgical episodes. Compared with patients who were not attributed to ACOs, the association between bundled payments and changes in postdischarge institutional spending was larger among patients attributed to ACOs (–$323 difference; 95% CI, –$607 to –$39; P = .03) for medical episodes, but not surgical episodes. Attribution to an ACO also increased the strength of the association between bundled payments and changes in 90-day readmissions for both medical episodes (−0.98 percentage point difference; 95% CI, –1.55 to –0.41; P = .001) and surgical episodes (−0.84 percentage point difference; 95% CI, −1.32 to −0.35; P = .001). In this cohort study, compared with inclusion in bundled payments alone, simultaneous inclusion in both ACOs and bundled payment programs was associated with lower institutional postacute care spending and readmissions for medical episodes and lower readmissions but not spending for surgical episodes. Receiving care under models such as ACOs may improve episode outcomes under bundled payments. This cohort study evaluates whether simultaneous inclusion in a Medicare accountable care organization and a bundled payment program was associated with better patient outcomes, compared with bundled payments alone.