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Bundled Payments for Care Improvement

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Study: Bundled-payment system for joint replacements cut cost by 20%

 

A study in the Journal of the American Medical Association found that bundled payments for joint replacements  can cut costs by up to 20.8 percent without hurting patients’ medical outcomes.

Researchers used Medicare claims to analyze 3,924 lower-extremity-joint replacement procedures at San Antonio-based Baptist Health System between July 2008 and June 2015. The patients took part in CMS’s voluntary Acute Care Episodes and Bundled Payments for Care Improvement demonstration projects.Among the findings:

  • The system achieved on average $5,577 in savings per joint-replacement episode.
  • During a seven-year period, Baptist Health System cut average Medicare costs by 20.8 percent for 3,738 joint replacements without complications.
  • For 204 episodes with complications, Medicare episode outlays fell an average 13.8 percent.
  • Episodes that required prolonged lengths of stay fell 67 percent.
  • Study researchers projected that if every hospital used the Baptist bundled-payment model, Medicare could save $2 billion a year.

For the study, researchers used Medicare claims to analyze 3,924 lower-extremity-joint-replacement procedures at San Antonio-based Baptist Health System between July 2008 and June 2015. The patients participated in CMS’s voluntary Acute Care Episodes and Bundled Payments for Care Improvement demonstration projects.

To read the JAMA article, please hit this link.


Mixed results from CMS’s orthopedic bundle initiative

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The CMS has released its second annual evaluation for Models 2-4 of the Bundled Payments for Care Improvement (BPCI) initiative, which details the results from the first year of the initiative, which, for now, involves orthopedic surgery.

Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer, called the results for orthopedic-surgery bundles encouraging, noting that under Model 2, participating hospitals were shown to have achieved statistically significant savings of $864 per episode while improving quality.

To read Dr. Conway’s remarks, please hit this link.

But, the report also showed that average payments for spinal-surgery episodes rose $3,477 more compared to the increase among nonbundling providers.

HealthcareDIVE commented:

“While the report stresses additional future analyses will be required to estimate any overall savings impact to Medicare, the CMS highlighted its optimism that 11 out of the 15 clinical episode groups that were analyzed did show indicators for potential savings.

“As more data become available over the next year and beyond, upcoming reports will be able to better estimate the BPCI initiative’s impacts on both costs and quality. This report, prepared by The Lewin Group, was the second of five planned annual reports. It looked at the experiences of Phase 2 participants in the first year of the initiative, in which episodes were initiated between October 2013 and September 2014. The report’s qualitative results reflect participants’ experiences through June 2015, the researchers said, noting that participation has continued to grow since, with more providers entering Phase 2 in April and July 2015.’’

To read the HealthcareDIVE analysis, please hit this link.

Meanwhile, CMS is moving ahead developing  additional bundled-payment models. Hit this link to look at one such model — cardiology. 


CMS offers 2-year extension for bundled-payment program

 

CMS is  offering participants in the Bundled Payments for Care Improvement initiative the option to extend participation an additional two years, says a blog post from Patrick Conway, M.D., CMS’s acting principal deputy administrator and chief medical officer.

Rather than ending the program this fall, participating providers can extend participation through Sept. 30, 2018.

Becker’s Hospital Review says that the agency hopes that “the extension will help it better determine the effectiveness of the program, which aims to incentivize providers to improve care coordination by paying for services patients receive across an episode of care, such as a heart bypass surgery or hip replacement.”

Dr. Conway wrote: “By extending their participation, CMS will be able to provide a more robust and rigorous evaluation of the initiative and determine whether the efforts of bundling payments are successful in providing better care while spending healthcare dollars more wisely”.

The initiative tests four payment models, which vary based on the services in the episode of care and whether payments are made prospectively or retrospectively. BPCI has 1,522 participants, nearly all of which are in Models 2, 3 and 4.

The extension will be available to providers in Models 2, 3 and 4 that began the BPCI initiative in October 2013 or in 2014.


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