Association of Medicare's Bundled Payments for Care Improvement initiative with patient-reported outcomes.

Abstract

To determine whether the Bundled Payments for Care Improvement (BPCI) initiative affected patient-reported measures of quality. Surveys of Medicare fee-for-service beneficiaries discharged from acute care hospitals participating in BPCI Model 2 and comparison hospitals between October 2014 and June 2017. Variables from Medicare administrative data and the Provider of Services file were used for sampling and risk adjustment. We estimated risk-adjusted differences in patient-reported measures of care experience and changes in functional status, for beneficiaries treated by BPCI and comparison hospitals. We selected a stratified random sample of BPCI and matched comparison beneficiaries. We fielded nine waves of surveys using a mail and phone protocol, yielding 29193 BPCI and 29913 comparison respondents. Most BPCI and comparison survey respondents reported a positive care experience and high satisfaction. BPCI respondents were slightly less likely than comparison respondents to report positive care experience or high satisfaction. Despite these differences in care experience, there was no difference between BPCI and comparison respondents in self-reported functional status approximately 90days after hospital discharge. These findings reduce concerns that BPCI may have unintentionally harmed patient health but suggest room for improvement in patient care experience.