Performance of Physician Groups and Hospitals Participating in Bundled Payments Among Medicare Beneficiaries.
Performance of Physician Groups and Hospitals Participating in Bundled Payments Among Medicare Beneficiaries.
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DOI：
10.1001/jamahealthforum.2022.4889
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发表时间：
2022-12-02
期刊：
影响因子：
--
通讯作者：
Navathe, Amol S.
中科院分区：
文献类型：
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作者：
Liao, Joshua M.;Huang, Qian;Wang, Erkuan;Linn, Kristin;Shirk, Torrey;Zhu, Jingsan;Cousins, Deborah;Navathe, Amol S.
与参与医院相比，参与医疗保险受益人捆绑支付的医生团体实践在事件结局方面是否表现出相似或不同的变化？这项具有差异中差异分析的队列研究发现，参与捆绑支付的医生团体实践与手术相关，但与医疗事件无关，而参与医院则与两种事件类型相关。这项队列研究的结果表明，政策制定者在设计和评估未来的捆绑支付模式时，应考虑参与者类型的比较性能。医院参与捆绑支付计划与财务节省和稳定的护理质量有关。然而，如何医生集团的做法（PGP）执行捆绑支付相比，医院仍然未知。评估PGP参与Bundled Payments for Care Improvement（BPCI）计划与事件结局的相关性，并将其与参与医院的结局进行比较。这项采用差异中差异分析的队列研究使用2011年至2018年的医疗保险索赔数据，比较了PGP与为医疗保险受益人提供医疗和手术护理的医院的BPCI参与与事件结局的相关性。数据分析于2020年1月1日至2022年5月31日进行。参与PGP和医院的Medicare患者因BPCI计划中包含的10次最高量发作（5次内科和5次外科）中的任何一次而住院。主要结局是90天总发作时间。次要结局为90天再入院和死亡率。总样本包括来自1 288 781名医疗保险受益人的数据，其中696 710人（平均[SD]年龄，76.2 [10.8]岁; 432 429 [59.7%]女性; 619 655 [85.5%]白色人）通过379家BPCI参与医院和1441家倾向匹配的非BPCI参与医院接受护理，592 071例（平均[SD]年龄，75.4 [10.9]岁; 527 574例[86.6%]女性; 360 835例[59.3%]白色个体）接受了参与BPCI的PGP中6405名医生和未参与BPCI的PGP中24 758名倾向匹配医生的治疗。对于PGP，BPCI参与与手术（差异，-1368美元; 95% CI，-1648美元至-1088美元）的发作支出减少相关，但与医疗发作（差异，-101美元; 95% CI，-410美元至206美元）无关。医院参与BPCI与手术（-1010美元; 95% CI，-1345美元至-675美元）和医疗（-763美元; 95% CI，-1139美元至-386美元）事件支出的更大减少相关。这项队列研究和对PGP和医院参与BPCI的差异分析发现，捆绑支付与PGP手术费用的节省以及医院手术和医疗费用的节省有关。政策制定者在设计和评估捆绑支付模式时应考虑参与者类型的比较业绩。这项队列研究评估了与参加医疗保险捆绑支付计划的医院相比，医生组的捆绑支付与每次医疗和手术事件的结局之间的关联。
Do physician group practices participating in bundled payments among Medicare beneficiaries exhibit similar or different changes in episode outcomes compared with participating hospitals? This cohort study with a difference-in-differences analysis found that physician group practices participating in bundled payments had associated savings with surgical but not medical episodes, whereas participating hospitals had savings associated with both episode types. The findings of this cohort study suggest that policy makers should consider the comparative performance of participant type when designing and evaluating future bundled payment models. Hospital participation in bundled payment initiatives has been associated with financial savings and stable quality of care. However, how physician group practices (PGPs) perform in bundled payments compared with hospitals remains unknown. To evaluate the association of PGP participation in the Bundled Payments for Care Improvement (BPCI) initiative with episode outcomes and to compare these with outcomes for participating hospitals. This cohort study with a difference-in-differences analysis used 2011 to 2018 Medicare claims data to compare the association of BPCI participation with episode outcomes for PGPs vs hospitals providing medical and surgical care to Medicare beneficiaries. Data analyses were conducted from January 1, 2020, to May 31, 2022. Hospitalization for any of the 10 highest-volume episodes (5 medical and 5 surgical) included in the BPCI initiative for Medicare patients of participating PGPs and hospitals. The primary outcome was 90-day total episode spending. Secondary outcomes were 90-day readmissions and mortality. The total sample comprised data from 1 288 781 Medicare beneficiaries, of whom 696 710 (mean [SD] age, 76.2 [10.8] years; 432 429 [59.7%] women; 619 655 [85.5%] White individuals) received care through 379 BPCI-participating hospitals and 1441 propensity-matched non−BPCI-participating hospitals, and 592 071 (mean [SD] age, 75.4 [10.9] years; 527 574 [86.6%] women; 360 835 [59.3%] White individuals) received care from 6405 physicians in BPCI-participating PGPs and 24 758 propensity-matched physicians in non−BPCI-participating PGPs. For PGPs, BPCI participation was associated with greater reductions in episode spending for surgical (difference, –$1368; 95% CI, –$1648 to –$1088) but not for medical episodes (difference, –$101; 95% CI, –$410 to $206). Hospital participation in BPCI was associated with greater reductions in episode spending for both surgical (–$1010; 95% CI, –$1345 to –$675) and medical (–$763; 95% CI, –$1139 to –$386) episodes. This cohort study and difference-in-differences analysis of PGPs and hospital participation in BPCI found that bundled payments were associated with cost savings for surgical episodes for PGPs, and savings for both surgical and medical episodes for hospitals. Policy makers should consider the comparative performance of participant types when designing and evaluating bundled payment models. This cohort study evaluates the association between bundled payments and episode outcomes per medical and surgical episodes for physician groups compared with hospitals participating in the Medicare bundled payments initiative.
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影响因子：
3.4
作者：
Zeldow B;Hatfield LA
通讯作者：
Hatfield LA
影响因子：
105.7
作者：
Rolnick, Joshua A.;Liao, Joshua M.;Navathe, Amol S.
通讯作者：
Navathe, Amol S.
影响因子：
6.3
作者：
Goodman-Bacon, Andrew
通讯作者：
Goodman-Bacon, Andrew
影响因子：
--
作者：
BLAND, JM;ALTMAN, DG
通讯作者：
ALTMAN, DG
在Medicare共享储蓄计划3年后，Medicare支出。
DOI：
10.1056/nejmsa1803388
发表时间：
2018-09-20
期刊：
The New England journal of medicine
影响因子：
--
作者：
McWilliams JM;Hatfield LA;Landon BE;Hamed P;Chernew ME
通讯作者：
Chernew ME