The impact of the Bundled Payment for Care Improvement Advanced on outcomes for patients with sepsis

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PROJECT SUMMARY Sepsis is a devastating condition resulting from the immune system’s reaction to infection. 1.7 million Americans are hospitalized annually with sepsis, resulting in over 270,000 deaths. Sepsis is more common among older patients, leading to spending among Medicare beneficiaries totaling $41B in 2018. Treatment costs and episode spending also vary widely across hospitals, driven largely by differences in post-acute care. In an attempt to improve care, sepsis was included as one of the 31 inpatient episodes targeted under Medicare’s Bundled Payment for Care Improvement Advanced (BPCI-A) program. BPCI-A is a voluntary program that creates incentives for hospitals to improve patient outcomes and reduce spending across a 90- day post-discharge episode. BPCI-A has the potential to encourage hospitals to more effectively manage patients during the admission to avoid subsequent complications and to discharge patients to lower acuity post-acute settings. At the same time, BPCI-A is not designed primarily to improve quality, and changes in patient outcomes – positive or negative – will be closely tied to hospital efforts to reduce spending. Patients with Alzheimer’s disease and related dementias (ADRD) are both more likely to develop sepsis and to have worse outcomes. Patients with ADRD have very high episode spending and are particularly vulnerable to adverse outcomes following discharge, making their treatment for sepsis under BPCI-A critically important to understand. Outside of ADRD, how patient risk and sepsis care pathways influence patient outcomes for sepsis in the context of BPCI-A are not well understood. In this context, we propose the following aims: Aim 1. Evaluate the effects of BPCI-A on outcomes for patients with sepsis. We will link hospital participation in BPCI- A with national Medicare data to test the effects of the program on mortality, readmission, post-acute care, days alive and at home, burdensome transitions, and discharge to hospice. Aim 2. Evaluate the effects of BPCI-A on outcomes for sepsis patients with ADRD. Using validated Medicare claims algorithms to identify patients with ADRD, we will test the impact of BPCI-A on outcomes for patients with ADRD. Aim 3. Understand the relationship between clinical risk, treatment, and post-acute care treatment patterns and outcomes under BPCI-A. Using unique data from the Michigan Sepsis Initiative linked to Medicare claims data, we will identify the clinical treatment patterns, patient risk factors, and hospital characteristics that predict patient outcomes. We will examine whether hospitals participating in BPCI-A deploy a different set of strategies to manage patients with sepsis. Our proposal is significant because it combines national data with detailed clinical insights to understand the interplay between national policy and nuanced clinical care for patients with sepsis. Our proposal is innovative in its combination of administration and registry data sources coupled with sophisticated quantitative methods to answer a novel question.