Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement - Advanced.
Changes in Cardiovascular Spending, Care Utilization, and Clinical Outcomes Associated With Participation in Bundled Payments for Care Improvement - Advanced.
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DOI：
10.1161/circulationaha.123.065109
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发表时间：
2023-10-03
期刊：
影响因子：
37.8
通讯作者：
Maddox, Karen E. Joynt
中科院分区：
文献类型：
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作者：
Shashikumar, Sukruth A.;Zheng, Jie;Orav, E. John;Epstein, Arnold M.;Maddox, Karen E. Joynt
关键词：
BPCI-A（Bundled Payments for Care Improvement - Advanced）是一项医疗保险计划，旨在激励减少从住院开始到出院后90天结束的护理支出。心血管疾病是医疗保险支出的重要驱动力，是BPCI-A的重点领域之一。尚不清楚BPCI-A是否与模型中3起心血管医学事件或5起心血管手术的支出减少或质量改善相关。在这项回顾性队列研究中，我们使用2017年1月1日至2019年9月30日期间出院的患者的医疗保险索赔进行了差异分析，以评估BPCI-A医院与匹配的非参与对照医院之间的差异。我们的主要结果是与对照组相比，在BPCI-A医院实施BPCI-A之前与之后，心脏医疗和手术条件的支出差异变化。次要结局包括患者复杂性、护理利用率、在家的健康天数、再入院率和死亡率的变化。BPCI-A医院心脏病医疗事件的基线支出为25606美元。BPCI-A与对照医院相比，心脏病医疗事件支出的差异变化为16美元（95% CI，-228至261美元; P=0.90）。BPCI-A医院心脏手术事件的基线支出为37961美元。心脏手术事件支出的差异变化为171美元（95% CI，-429至772美元; P=0.58）。医生的护理模式，如复杂的治疗病人或在他们的护理利用有最小的差异变化。在BPCI-A与对照医院，90天再入院率没有显著差异变化（医疗事件的差异变化为0.27% [95% CI，-0.25%至0.80%];差异变化，0.31% [95% CI，−0.98%至1.60%]（手术事件）或死亡率（医疗事件的差异变化为−0.14% [95% CI，−0.50%至0.23%];手术事件的差异变化为−0.36% [95% CI，−1.25%至0.54%]）。参与BPCI-A与模型中提供的心血管医疗事件或程序的支出减少、护理利用率变化或质量改善无关。
Bundled Payments for Care Improvement – Advanced (BPCI-A) is a Medicare initiative that aims to incentivize reductions in spending for episodes of care that start with a hospitalization and end 90 days after discharge. Cardiovascular disease, an important driver of Medicare spending, is one of the areas of focus BPCI-A. It is unknown whether BPCI-A is associated with spending reductions or quality improvements for the 3 cardiovascular medical events or 5 cardiovascular procedures in the model. In this retrospective cohort study, we conducted difference-in-differences analyses using Medicare claims for patients discharged between January 1, 2017, and September 30, 2019, to assess differences between BPCI-A hospitals and matched nonparticipating control hospitals. Our primary outcomes were the differential changes in spending, before versus after implementation of BPCI-A, for cardiac medical and procedural conditions at BPCI-A hospitals compared with controls. Secondary outcomes included changes in patient complexity, care utilization, healthy days at home, readmissions, and mortality. Baseline spending for cardiac medical episodes at BPCI-A hospitals was $25 606. The differential change in spending for cardiac medical episodes at BPCI-A versus control hospitals was $16 (95% CI, −$228 to $261; P=0.90). Baseline spending for cardiac procedural episodes at BPCI-A hospitals was $37 961. The differential change in spending for cardiac procedural episodes was $171 (95% CI, −$429 to $772; P=0.58). There were minimal differential changes in physicians’ care patterns such as the complexity of treated patients or in their care utilization. At BPCI-A versus control hospitals, there were no significant differential changes in rates of 90-day readmissions (differential change, 0.27% [95% CI, −0.25% to 0.80%] for medical episodes; differential change, 0.31% [95% CI, −0.98% to 1.60%] for procedural episodes) or mortality (differential change, −0.14% [95% CI, −0.50% to 0.23%] for medical episodes; differential change, −0.36% [95% CI, −1.25% to 0.54%] for procedural episodes). Participation in BPCI-A was not associated with spending reductions, changes in care utilization, or quality improvements for the cardiovascular medical events or procedures offered in the model.