CMS on Monday released a report on the first year of the voluntary Bundled Payments for Care Improvement (BPCI) initiative, which found that some episode payments yielded savings, while others did not.
BPCI, established by the Center for Medicare and Medicaid Innovation, is comprised of four broadly defined care models that link bundled payments for multiple services received during an episode of care.
The voluntary demonstration project launched in 2013. Models 1 and 4 apply to inpatient hospital care. Models 2 and 3 involve post-acute care.
As of July, 1,448 participants were enrolled in BPCI, including acute-care hospitals, skilled-nursing facilities, and physician group practices.
The report, prepared by the Lewin Group, analyzed 15 clinical episode groups for Models 2, 3, and 4 of BPCI. The episodes were initiated between October 2013 and September 2014. The report analyzed a total of about 60,000 episodes of care.
Overall, the report found that 11 of the 15 clinical episode groups had the potential to save CMS money, and that there were "isolated instances of quality declines and fewer instances of increased quality."
The results varied by type of care episode. Relative to comparison hospitals, orthopedic surgery episodes initiated at BPCI Model 2 hospitals were associated with "statistically significant" savings of 3 percent, or $864, per episode on Medicare payments for hospitalization and 90-days post-discharge. CMS attributed the savings to the reduced use of institutional post-acute care after hospitalization.
In addition, orthopedic surgery patients who received care at Model 2 hospitals reported greater improvements in two measures of mobility 90 days post-discharge compared with patients at other hospitals.
Meanwhile, cardiovascular surgery episodes performed at Model 2 hospitals did not yield savings or show any difference in quality. Spinal surgery episodes were associated with increased Medicare payments, but decreased mortality rates.
More data needed
CMS CMO Patrick Conway called the report "encouraging," but added the early data were not enough to fully understand the program's effects on costs and outcomes.
"Future evaluation reports will have greater ability to detect changes in payment and quality due to larger sample sizes and the recent growth in participation of the initiative, which generally is not reflected in this report," he wrote in a blog post.
The report authors agreed. "More study is needed before generalizing these results to other providers or the full range of clinical episodes," they wrote (Whitman, Modern Healthcare, 9/19; Gooch, Becker's Hospital CFO, 9/19; Conway, CMS blog, 9/19; CMS report, accessed 9/20).
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