Evaluation of Medicare's Bundled Payments Initiative for Medical Conditions
Evaluation of Medicare's Bundled Payments Initiative for Medical Conditions
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DOI：
10.1056/nejmsa1801569
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发表时间：
2018-07-19
影响因子：
158.5
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
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作者：
Maddox, Karen E. Joynt;Orav, E. John;Epstein, Arnold M.
背景医疗保险和医疗补助创新中心 (CMMI) 于 2013 年推出了医疗改善捆绑支付 (BPCI) 计划。随后的一项研究表明，该计划与全关节置换术的医疗保险付款减少有关，但人们对 BPCI 对医疗状况的影响知之甚少。方法我们使用 2013 年至 2015 年的医疗保险索赔来确定 BPCI 中最常选择的五种医疗状况的入院情况：充血性心力衰竭（CHF）、肺炎、慢性阻塞性肺病（COPD）、败血症和急性心肌梗死（AMI）。我们使用双重差分分析来评估 BPCI 医院和匹配对照医院针对这些病症每次护理（定义为住院加出院后 90 天）的标准化医疗保险支付的变化。结果共有 125 家医院参与了治疗 CHF 的 BPCI、105 家医院参与了肺炎、101 家医院参与了 COPD、88 家医院参与了脓毒症、73 家医院参与了 AMI。基线时，BPCI 医院五种情况下每次护理的平均医疗保险费用为 24,280 美元，在干预期间下降至 23,993 美元（差异 - 286 美元；P=0.41）。对照医院对所有事件的平均付款为 23,901 美元，在干预期间降至 23,503 美元（差异，-398 美元；P=0.08；差异差异，112 美元；P=0.79）。从基线到干预期，临床复杂性、住院时间、出院后 30 或 90 天内急诊科使用或再入院、或入院后 30 或 90 天内死亡的变化在干预医院和对照医院之间没有显着差异。结论：医院参与 BPCI 下的五种常见医疗套餐与医疗保险支付、临床复杂性、住院时间、急诊科使用、再入院或死亡率的显着变化无关。
BACKGROUNDThe Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. A subsequent study showed that the initiative was associated with reductions in Medicare payments for total joint replacement, but little is known about the effect of BPCI on medical conditions.METHODSWe used Medicare claims from 2013 through 2015 to identify admissions for the Five most commonly selected medical conditions in BPCI: congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction (AMI). We used difference-in-differences analyses to assess changes in standardized Medicare payments per episode of care (defined as the hospitalization plus 90 days after discharge) for these conditions at BPCI hospitals and matched control hospitals.RESULTSA total of 125 hospitals participated in BPCI for CHF, 105 hospitals for pneumonia, 101 hospitals for COPD, 88 hospitals for sepsis, and 73 hospitals for AMI. At baseline, the average Medicare payment per episode of care across the five conditions at BPCI hospitals was $24,280, which decreased to $23,993 during the intervention period (difference, -$286; P=0.41). Control hospitals had an average payment for all episodes of $23,901, which decreased to $23,503 during the intervention period (difference, -$398; P=0.08; difference in differences, $112; P=0.79). Changes from baseline to the intervention period in clinical complexity, length of stay, emergency department use or readmission within 30 or 90 days after hospital discharge, or death within 30 or 90 days after admission did not differ significantly between the intervention and control hospitals.CONCLUSIONSHospital participation in five common medical bundles under BPCI was not associated with significant changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission, or mortality.