scholarly journals Association Between Medicare’s Mandatory Joint Replacement Bundled Payment Program and Post–Acute Care Use in Medicare Advantage

JAMA Surgery ◽  
2020 ◽  
Vol 155 (1) ◽  
pp. 82 ◽  
Author(s):  
Andrew D. Wilcock ◽  
Michael L. Barnett ◽  
J. Michael McWilliams ◽  
David C. Grabowski ◽  
Ateev Mehrotra
Keyword(s):  
Acute Care ◽  
Joint Replacement ◽  
Medicare Advantage ◽  
Bundled Payment ◽  
Post Acute Care

The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes

2021 ◽  
Author(s):  
Joshua M Liao ◽  
Paula Chatterjee ◽  
Erkuan Wang ◽  
John Connolly ◽  
Jingsan Zhu ◽  
...  
Keyword(s):  
Acute Care ◽  
Low Income ◽  
Safety Net ◽  
Care Utilization ◽  
Difference In Differences ◽  
Bundled Payment ◽  
Hospital Safety ◽  
Percentage Points ◽  
Acute Care Utilization ◽  
Post Acute Care

BACKGROUND: Under Medicare’s Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges. OBJECTIVE: To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes. DESIGN, SETTING, AND PARTICIPANTS: This observational difference-in-differences analysis was conducted in safety net and non–safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011-2016 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. EXPOSURE(S): Hospital BPCI participation and safety net status. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was postdischarge spending. Secondary outcomes included quality and post–acute care utilization measures. RESULTS: Our sample consisted of 803 safety net and 2263 non–safety net hospitals. Safety net hospitals were larger and located in areas with more low-income individuals than non–safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference-in-differences [aDID], $40; 95% CI, –$254 to $335; P = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post–acute care (aDID, 1.06 percentage points; 95% CI, 0.37-1.76; P = .003) and lower discharge home with home health (aDID, –1.15 percentage points; 95% CI, –1.73 to –0.58; P < .001) than BPCI non–safety net hospitals. CONCLUSIONS: Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post–acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.

Post‐Acute Care After Joint Replacement in Medicare's Bundled Payments for Care Improvement Initiative

2019 ◽  
Vol 67 (5) ◽  
pp. 1027-1035 ◽  
Author(s):  
Karen E. Joynt Maddox ◽  
E. John Orav ◽  
Jie Zheng ◽  
Arnold M. Epstein
Keyword(s):  
Acute Care ◽  
Joint Replacement ◽  
Bundled Payments ◽  
Care Improvement ◽  
Post Acute Care

scholarly journals Variation in expenditure for common, high cost surgical procedures in a working age population: implications for reimbursement reform

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
W. Wynn-Jones ◽  
T. P. Koehlmoos ◽  
C. Tompkins ◽  
A. Navathe ◽  
S. Lipsitz ◽  
...  
Keyword(s):  
Acute Care ◽  
Knee Replacement ◽  
Surgical Procedures ◽  
Cost Of Care ◽  
Index Procedure ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Working Age ◽  
Working Age Population ◽  
Post Acute Care

Abstract Background In the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments’ ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18–65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy. Methods Five procedures conducted on adults aged 18–65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure. Results After adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG). Conclusions This study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.

Abstract TP309: Creating a Crystal Ball: Predicting Successful Rehabilitation for Optimal Discharge Placement

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Ermak ◽  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Kathy Morrison ◽  
Travis Lehman
Keyword(s):  
Acute Care ◽  
Care Delivery ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Stroke Patients ◽  
Skilled Nursing ◽  
Bundled Payment ◽  
Successful Rehabilitation ◽  
Care Improvement ◽  
Post Acute Care

Introduction: In 2014, the Centers for Medicare and Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) program. Our institution is contracted for a 90 day stroke bundle, making us responsible for all Medicare stroke patient costs. Quarterly review of 2015 financial data (DRG 64 & 65) revealed a significant spend occurs in the post-acute care phase. Methods: Detailed analysis and sequencing revealed that of the 40% of patients discharged to an Inpatient Rehab Facility (IRF) 31% were unsuccessful in rehabilitation and instead transitioned to a Skilled Nursing Facility (SNF). Had SNF been initially selected, a cost avoidance of $292,650 would have been appreciated. Conclusion: Involvement in the BPCI program has provided insight into the post-acute care of stroke patients. With the advent of BPCI, institutions will be increasingly held fiscally responsible for post-acute care delivery. Ongoing retrospective chart review and collaboration with Physical Medicine and Rehabilitation colleagues is underway to identify key indicators that would project successful rehabilitation. Analysis will include comparison between those who were successfully discharged home after an IRF stay to those that needed a SNF after an IRF stay. This would provide inpatient teams with strategies for predicting the optimal discharge location for stroke patients.

scholarly journals THE IMPACT OF MEDICARE ADVANTAGE ON SKILLED NURSING FACILITY FINANCIAL PERFORMANCE, STAFFING, AND QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S547-S547
Author(s):  
John R Bowblis ◽  
Sean Huang
Keyword(s):  
Financial Performance ◽  
Acute Care ◽  
Medicare Beneficiary ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Medicare Advantage ◽  
Data Set ◽  
Skilled Nursing ◽  
The Impact ◽  
Post Acute Care

Abstract Since the mid-2000s, skilled nursing facilities (SNFs) face an increasing percentage of post-acute care patients enrolled in Medicare Advantage (MA), yet our understanding the of how this affects SNFs is limited. Managed care may provide better coordination and continuous care that enhances SNF quality, but MA plans can also negotiate lower payments, providing SNFs with fewer financial resources to invest in staffing and quality. We use data from 2011-2015 from Medicare Beneficiary Summary File, Minimum Data Set, Certification and Survey Provider Enhanced Reporting, and Medicare Cost Reports to estimate linear fixed effect panel regressions with instrumental variables. We find that SNFs with greater MA share of post-acute care admissions have worse financial performance, lower nursing staff levels, and worse quality as measured by deficiency scores. Our finding favors the hypothesis that MA creates downward financial pressure and strong MA presence in local markets can potentially to spillover to non-MA residents.

New Post-Acute Care Quality Measures Take Effect Oct. 1

ASHA Leader ◽  
2016 ◽  
Vol 21 (6) ◽  
pp. 34-35
Author(s):  
Sarah Warren ◽  
Tim Nanof
Keyword(s):  
Acute Care ◽  
Quality Measures ◽  
Care Quality ◽  
Post Acute Care

Moving in, taking charge in the post-acute care realm

2013 ◽  
Vol 6 (2) ◽  
pp. 1-25
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Acute Care ◽  
Taking Charge ◽  
Post Acute Care
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