Predictors of Success in the Bundled Payments for Care Improvement Program.
Predictors of Success in the Bundled Payments for Care Improvement Program.
复制标题
护理改善计划捆绑付款成功的预测因素。
DOI：
10.1007/s11606-021-06820-7
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发表时间：
2022
影响因子：
5.7
通讯作者：
JoyntMaddox,KarenE
中科院分区：
文献类型：
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作者：
Wolfe,JonathanD;Epstein,ArnoldM;Zheng,Jie;Orav,EJohn;JoyntMaddox,KarenE
摘要背景参与医疗保险的捆绑支付护理改善（BPCI）计划的医院被鼓励减少医疗保险支付的护理事件。目的确定影响医院是否能够在BPCI项目中节省费用的因素，不同服务的成本如何变化以产生这些节省，以及“节省者”是否具有较低或降低的护理质量。设计回顾性队列研究。参与者BPCI参与医院。主要措施我们指定达到计划目标的医院为“储蓄者”，即每90天的平均医疗保险支付费用从基线降低至少2%。我们使用回归模型来确定与储蓄相关的条件水平，患者水平，医院水平和市场水平特征。总共有421家医院参与了BPCI，产生了2974个医院条件组合。下肢大关节置换术的储蓄者比例最高（77.6%，平均变化为-2235），复杂非颈椎融合术的储蓄者比例最低（22.2%，平均变化为+8106）。医疗条件比手术条件有更高的储蓄比例（11%更有可能储蓄，P= 0.001）。大多数紧急/紧急的情况下，储蓄者的比例高于大多数选择性的情况（储蓄的可能性高6%，P= 0.007）。基线时高于中位数的成本与储蓄相关（OR：3.02，P< 0.001）。有更复杂患者的医院不太可能保存（OR：0.77，P= 0.003）。在住院和急性期后护理方面都节省了费用，而且作为节省者，临床护理没有减少。结论某些情况下可能比其他人更适合节省捆绑支付，和医院的基线成本高，可能会执行良好的计划，使用医院自己的基线成本设定目标。研究结果可能对BPCI-Advanced计划和寻求使用支付模式来推动护理改善的政策制定者产生影响。
Abstract Background Hospitals participating in Medicare’s Bundled Payments for Care Improvement (BPCI) program were incented to reduce Medicare payments for episodes of care. Objective To identify factors that influenced whether or not hospitals were able to save in the BPCI program, how the cost of different services changed to produce those savings, and if “savers” had lower or decreased quality of care. Design Retrospective cohort study. Participants BPCI-participating hospitals. Main Measures We designated hospitals that met the program goal of decreasing costs by at least 2% from baseline in average Medicare payments per 90-day episode as “savers.” We used regression models to determine condition-level, patient-level, hospital-level, and market-level characteristics associated with savings. Key Results In total, 421 hospitals participated in BPCI, resulting in 2974 hospital-condition combinations. Major joint replacement of the lower extremity had the highest proportion of savers (77.6%, average change in payments− 2235)andcomplexnon-cervicalspinalfusionhadthelowest(22.2%,averagechange+ 8106). Medical conditions had a higher proportion of savers than surgical conditions (11% more likely to save, P= 0.001). Conditions that were mostly urgent/emergent had a higher proportion of savers than conditions that were mostly elective (6% more likely to save, P= 0.007). Having higher than median costs at baseline was associated with saving (OR: 3.02, P< 0.001). Hospitals with more complex patients were less likely to save (OR: 0.77, P= 0.003). Savings occurred across both inpatient and post-acute care, and there were no decrements in clinical care associated with being a saver. Conclusions Certain conditions may be more amenable than others to saving under bundled payments, and hospitals with high costs at baseline may perform well under programs which use hospitals’ own baseline costs to set targets. Findings may have implications for the BPCI-Advanced program and for policymakers seeking to use payment models to drive improvements in care.