Medicare Bundled Payments for Common Conditions Fail to Make Impact

Following the launch of the Bundled Payments for Care Improvement (BPCI) by the Center for Medicare and Medicaid Innovation in 2013, a new study published in the New England Journal of Medicine, found that hospital 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.

Although a subsequent study showed that the BPCI initiative was associated with reductions in Medicare payments for total joint replacement, little is known about the effect of BPCI on other medical conditions. To better understand this, the research team led by Karen Joynt Maddox, MD, assistant professor of medicine at the Washington University School of Medicine, and colleagues, used Medicare claims from 2013 through 2015 to identify admissions for the five most commonly selected medical conditions in BPCI. They found that the most common conditions included, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), sepsis, and acute myocardial infarction.

“Because BPCI and BPCI Advanced include a wide variety of clinical conditions, there is a critical need for information on how bundled-payment models might change patterns of care for medical conditions,” Dr Maddox and colleagues wrote.

In order to assess changes in standardized Medicare payments per episode of care for the identified conditions at BPCI hospitals and matched control hospitals, which was defined as the hospitalization plus 90 days after discharge, the researchers conducted a difference-in-differences analyses. The researchers identified a total of 125 hospitals that participated in BPCI for congestive heart failure, 105 hospitals for pneumonia, 101 hospitals for COPD, 88 hospitals for sepsis, and 73 hospitals for acute myocardial infarction.

At the baseline of the study, the researchers found that the average Medicare payment per episode of care across all five conditions at BPCI hospitals was $24,280, which decreased to $23,993 during the intervention period. Further, control hospitals had an average payment for all episodes of $23,901, which decreased to $23,503 during the intervention period. The researchers noted that 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 both the intervention and control hospitals.

“Hospital 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,” Dr Maddox and colleagues concluded.

—Julie Gould

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