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

Medicare Bundled Payments for Post-Acute Care: Characteristics and Baseline Performance of Participating Skilled Nursing Facilities

2018 ◽  
Vol 77 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Xi Cen ◽  
Helena Temkin-Greener ◽  
Yue Li
Keyword(s):  
Acute Care ◽  
Market Competition ◽  
Cost Of Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Bundled Payments ◽  
Baseline Performance ◽  
Care Improvement ◽  
Post Acute Care

Medicare bundled payment models have focused on post-acute care as a key component of improving the efficiency and quality of health care. This study investigated the characteristics and baseline performance of skilled nursing facilities (SNFs) that participated in Medicare Bundled Payments for Care Improvement Initiative Model 3. As of July 2016, 657 SNFs participated in 7,932 episodes in risk-bearing phase. Our retrospective analyses found that larger facilities, higher occupancy rate, chain affiliation, better five-star overall rating, and higher market competition for SNF care were associated with increased likelihood of enrolling in clinical episodes in Model 3, whereas not-for-profit ownership, higher adjusted staffing levels, higher percentage of Medicaid residents, and rural location were associated with reduced likelihood of participation in Bundled Payments for Care Improvement. Policy makers should consider approaches to encourage participation of post-acute care providers in this voluntary program and evaluate its impact on patient selection, cost of care, and health outcomes.

Medicare bundles for arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 119-125
Author(s):  
Bryan D. Springer ◽  
Jordan McInerney
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Drop Out ◽  
Retention Rates ◽  
Fee For Service ◽  
Target Price ◽  
High Performing ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Care Improvement

Aims There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service. Methods Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). With rebasing of Target Prices in 2020 and opportunity for participants to drop out, we compared retention rates of hospitals and physician groups enrolled at the onset of BPCI Advanced with current enrolment in 2020. Results At its peak in July 2015, 342 acute care hospitals and physician groups participated in Lower Extremity Joint Replacement (LEJR) in BPCI Classic. At its peak in March 2019, 534 acute care hospitals and physician groups participated in LEJR in BPCI Advanced. In January 2020, only 14.5% of legacy hospitals and physician groups opted to stay in BPCI Advanced for LEJR. Analysis of Target Price factors by legacy hospitals during both programmes demonstrates that participants in BPCI Classic received larger negative adjustments on the Target Price than non-legacy hospitals. Conclusion BPCI Advanced provides little opportunity for a reduction in cost to offset a reduced Target Price for efficient providers, as made evident by the 85.5% withdrawal rate for BPCI Advanced. Efficient providers in BPCI Advanced are challenged by the programme’s application of trend and efficiency factors that presumes their cost reduction can continue to decline at the same rate as non-efficient providers. It remains to be seen if reverting back to Medicare fee for service will support the same level of care and quality achieved in historical bundled payment programmes. Cite this article: Bone Joint J 2021;103-B(6 Supple A):119–125.

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

Lessons learned from Heart Failure Bundle Payment Care Improvement: Post-acute Care Focus

2017 ◽  
Vol 23 (8) ◽  
pp. S87
Author(s):  
Jenny Stachura ◽  
Stacy Cerio ◽  
Sara Lawler ◽  
Tish Outhet ◽  
Christine Shank ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Care ◽  
Lessons Learned ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document