Bundled Payment Research Articles

Hierarchical Payment Models—A Path for Coordinating Population- and Episode-Based Payment Models

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue

Motivations of Retailers Accepting Cryptocurrency Payments and Their Implications on Retail Customer Experience

The level of technology use of humanity has increased, while the interest in digital assets has increased with the effect of the pandemic period. This increasing interest has led to curiosity about what kind of consumer experience cryptocurrencies will offer when used in retail shopping. This study aims to reveal the advantages and disadvantages of using cryptocurrencies in shopping based on the experiences of businesses that accept payments with cryptocurrencies. Interviews were conducted with 9 businesses in Turkey that accept payments with crypto money using the in-depth interview technique in this study. As a result of the content analysis carried out with the NVivo analysis program for the findings, a research model was proposed. The results of this research point out that crypto currencies are preferred by consumers and retailers due to the fact that they are a fast, safe and cheap global payment tool. However, it has been found that there are also consumers who are totally unaware of the existence of payments with crypto currencies. Some consumers do not prefer payments with crypto currencies either because of low technology usage level or lack of trust to the system. However, when necessary legal sub-regulations are made and everything is digitized, money will also become digital in the common opinion. Unlike the studies in the literature, as a result of this study, it is predicted that payments with crypto money will be one of the alternative payment tools of the future, after the cryptocurrencies are positioned on a legal platform by the official authorities.

Medicare Bundled Payment Model for Total Ankle Arthroplasty

Category:Ankle; OtherIntroduction/Purpose:Total ankle arthroplasty (TAA) is included in the Centers of Medicare and Medicaid Services' (CMS) Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacements. This model has been demonstrated to be for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there remains concern that the model underestimates expected costs for TAA due to the unique healthcare needs of TAA patients including higher implant costs, longer procedures, and an increased demand for postoperative acute care services due to non-weightbearing. The purpose of this study was to analyze the breakdown of costs associated with inpatient and outpatient care and assess the difference between Medicare beneficiary reimbursements and actual costs for the episode of care.Methods:An IRB-approved retrospective review was conducted of patients with Medicare who underwent TAA between July 2014 and June 2018. The surgeries were performed at seven facilities affiliated with a singular institution hospital system. Patients undergoing TAA in this time period were identified using an institutional arthroplasty database and were eligible for study. Of 99 patients who met this criterion, financial data was available for 72. Demographics including age, gender, BMI, and comorbidities were collected via chart review. Episode start and end dates, first post-acute care discharge destination, and total episode costs were recorded. Total episode cost was subdivided into inpatient facility cost, surgeon fees, and post-acute care discharge costs (inpatient rehab facility costs, skilled nursing facility expenses, or home health aide fees). Patients were stratified into two groups based on 90-day costs of care, a 'positive group' not exceeding the bundled payment allocation and a 'negative group' which did exceed.Results:No statistically significant difference was found among demographics between the positive and negative patient groups. Average group age was 70.5 years and 72.9 years, respectively, and both groups had average BMI of 29.3 kg/m2. Age-adjusted Charlson Comorbidity Index was 3.35 for the positive group and 3.40 for the negative group. Total episode costs were 50% higher in the negative group compared to the positive group ($31,462 vs. $15,845). The total post discharge costs for the negative group were $17,912 which is significantly higher than those of the positive group ($2,502) (P<0.001). Thirteen patients (18.1%) attended skilled nursing facilities, and 12 of these patients exceeded the allocated budget. Average SNF cost was $13,089, which nearly matched the entire inpatient cost (facility + surgeon fees) of $13,400. Home health aide requirement was significant at 39% (n=28), and 15 of these patients (54%) also came in over budget.Conclusion:Results suggest that there is a considerable possibility for patients undergoing TAA to have post-acute care requirements that drive cost over budget, including admittance to skilled nursing facilities and home health aide, likely sue to the added necessity for extended immobilization in an older patient population. Such parameters should be factored into the BPCI reimbursement model for TAA.

Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare

Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare

РОССИЙСКО-КИТАЙСКОЕ ЭКОНОМИЧЕСКОЕ СОТРУДНИЧЕСТВО В КОНЦЕПЦИИ ГЛОБАЛЬНОЙ ЦИФРОВИЗАЦИИ

The article is devoted to the analysis of the formation on the territory of Eurasia of an international credit and financial institution, which has some common features with the International Monetary Funds, on the basis of partnership with the participation of China, India, Pakistan, Iran and other countries. This international integration financial and credit institution can become a reality only on the basis of the general global digitalization of the countries that are members of the union. This integral community will remain open to other states. The contradictions that arise during international integration can receive their civilized forms of resolution in the model of the conflict-compromise paradigm. This formulation of the problem of the formation of an international financial and credit institution in the territory of responsibility of the countries of Southeast Asia, Russia, the countries of the Eurasian Economic Union made it possible to finally undermine the position of the US dollar in international settlements. The purpose and objectives of the study are to reveal the global trend in the formation of a new financial and economic reality in the context of increasing activity in the formation of a single digital space, switching to settlements in national currencies and switching to digital currency means of payment in settlements, and in the future, to global reserve digital payment instruments facilities. The object of the study is the regional financial and credit system, which is capable of reducing the risks of losses of foreign exchange funds from the implementation of the hostile sanctions policy of other states, primarily the United States. The subject of the study is the model for creating global means of payment based on digital currency means of payment of countries that are members of the Union of Southeast Asian countries, Russia, as well as other countries wishing to join the Union. The conclusions obtained have scientific and practical value as a result of sufficient verification, provided by the use of modern scientific research methods, including historical and logical, comparative analysis, methods of scientific induction, comparative analysis. The use of a comparative-functional, systematic approach makes it possible to obtain results that have a sufficient evidence-based, methodological basis in the formation of the Eurasian Monetary Fund. The analysis of modern economic and political literature testifies to the recognition of a large theoretical and practical problem regarding the new architecture of economic, financial, and monetary relations within the framework of the proposed future model of the Eurasian Payments Union

An Overview of the Radiation Oncology Alternative Payment Model and Impact on Practices Serving Vulnerable Populations.

Radiation oncology reimbursement methodology has been largely unchanged over the past 30 years, and new approaches are of great interest to practicing radiation oncologists and other health care stakeholders. Traditional radiation oncology reimbursement is based on a series of individual codes for evaluation and management (professional) and technical services, yielding a complex reimbursement system. In an attempt to move toward a simpler, episodic payment model, bundling all of the codes into a single payment, an alternative payment model for radiation oncology was developed. The radiation oncology alternative payment model is a revolutionary change in how radiation oncologic services will be reimbursed and has potential to affect all aspects of radiation oncologic care. Here, the authors review the origin of the currently proposed radiation oncology model and discuss potential implications of this model on the provision of care, especially as it relates to rural practices and other underserved and vulnerable patient populations.

ACO Investment Model Produced Savings, But The Majority Of Participants Exited When Faced With Downside Risk.

Medicare's Accountable Care Organization (ACO) Investment Model (AIM) provided up-front funding to forty-one small, rurally located ACOs to encourage their participation in the Medicare Shared Savings Program. We estimate net savings to Medicare of $381.5 million over three years, driven by utilization reductions in inpatient and other institutional care and by the absence of shared risk for potential increases in Medicare spending incurred by participants. These savings suggest that population-based payment models can enable providers to better meet the needs of rural populations through greater flexibility in care delivery. However, nearly two-thirds of AIM ACOs exited the Medicare Shared Savings Program when faced with the requirement to assume downside financial risk, starting in year four of participation. As the Centers for Medicare and Medicaid Services builds on AIM and rural hospital global payment models, our findings suggest that new payment models can support more efficient use of resources to meet the health care needs of rural populations. However, the findings also caution against the vigorous pursuit of savings as a primary goal of payment models in traditionally underserved communities.

The exclusive nature of global payments infrastructures: the significance of major banks and the role of tech-driven companies

Despite the narrative of a globalized economy, there is no effectively working global payment system. Although there is an infrastructure that allows the transmission of data about global payments, the movement of actual money is executed indirectly, making it an incalculable endeavor. The reason is that money is not simply data, but a complex bundle of rights closely tied to the nation state. In the absence of infrastructure that reliably links payments with guarantees of the nation state, intermediaries that facilitate global payments are forced to create trust in a different way. This is only possible by occupying a highly centralized and therefore powerful position. In this article, we investigate which actors were historically able to hold such a position and how these actors are challenged by digitalization. We suggest that there are three models of payment infrastructure provision. Bank-based systems were dominant until the 1980s, but in the following decades, a second model emerged: the provision of financial infrastructure by global companies. Since the early 2000s, we see a third model: the entrance of tech-driven companies in the payment sector. We conclude that digital technologies will not necessarily solve the problems, but might in fact exacerbate them.

Cost-Utility Analysis of the Integrated Care Models for the Management of Hypertension Patients: A Quasi-Experiment in Southwest Rural China

Background: Hypertension has become the second-leading risk factor for death worldwide. However, the fragmented three-level “county–township–village” medical and healthcare system in rural China cannot provide continuous, coordinated, and comprehensive health care for patients with hypertension, as a result of which rural China has a low rate of hypertension control. This study aimed to explore the costs and benefits of an integrated care model using three intervention modes—multidisciplinary teams (MDT), multi-institutional pathway (MIP), and system global budget and performance-based payments (SGB-P4P)—for hypertension management in rural China.Methods: A Markov model with 1-year per cycle was adopted to simulate the lifetime medical costs and quality-adjusted life-years (QALYs) for patients. The interventions included Option 1 (MDT + MIP), Option 2 (MDT + MIP + SGB–P4P), and the Usual practice (usual care). We used the incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB), and net health benefit (NHB) to make economic decisions and a 5% discount rate. One-way and probability sensitivity analyses were performed to test model robustness. Data on the blood pressure control rate, transition probability, utility, annual treatment costs, and project costs were from the community intervention trial (CMB-OC) project.Results: Compared with the Usual practice, Option 1 yielded an additional 0.068 QALYs and an additional cost of $229.99, resulting in an ICER of $3,373.75/QALY, the NMB was –$120.97, and the NHB was −0.076 QALYs. Compared with the Usual practice, Option 2 yielded an additional 0.545 QALYs, and the cost decreased by $2,007.31, yielding an ICER of –$3,680.72/QALY. The NMB was $2,879.42, and the NHB was 1.801 QALYs. Compared with Option 1, Option 2 yielded an additional 0.477 QALYs, and the cost decreased by $2,237.30, so the ICER was –$4,688.50/QALY, the NMB was $3,000.40, and the NHB was 1.876 QALYs. The one-way sensitivity analysis showed that the most sensitive factors in the model were treatment cost of ESRD, human cost, and discount rate. The probability sensitivity analysis showed that when willingness to pay was $1,599.16/QALY, the cost-effectiveness probability of Option 1, Option 2, and the Usual practice was 0.008, 0.813, and 0.179, respectively.Conclusions: The integrated care model with performance-based prepaid payments was the most beneficial intervention, whereas the general integrated care model (MDT + MIP) was not cost-effective. The integrated care model (MDT + MIP + SGB-P4P) was suggested for use in the community management of hypertension in rural China as a continuous, patient-centered care system to improve the efficiency of hypertension management.

The Spillover Effect of the Medicare Mandatory Bundled Payment Program on Joint Replacement Outcomes: Analysis of Patients with Commercial Insurance and Medicare Advantage.

To improve the value and efficiency of care among traditional Medicare enrollees, the Centers for Medicare & Medicaid Services has implemented alternative payment models designed to control health-care spending and improve quality. These models may affect care beyond traditional Medicare enrollees, "spilling over" into other populations. Established in April 2016, the Medicare mandatory bundled payment program, called the Comprehensive Care for Joint Replacement (CJR) model, holds hospitals accountable for spending and quality of care for traditional Medicare joint-replacement patients during care episodes that span from the index hospitalization to 90 days post-discharge. We assessed the extent to which the CJR model was associated with outcomes for patients enrolled in commercial insurance and Medicare Advantage plans. With use of Health Care Cost Institute claims data from 2012 through 2017, we assessed the association of the CJR model with total expenditures, discharges to institutional post-acute care, and readmissions among commercial insurance and Medicare Advantage joint-replacement patients. The exposure variable was the implementation of the CJR model in 67 randomly selected metropolitan statistical areas compared with 103 similar areas without CJR implementation. We utilized difference-in-differences models to estimate the spillover effects of the CJR model by comparing outcomes between these areas before and after CJR implementation. The study included 174,893 joint-replacement episodes of care in commercial insurance enrollees and 202,070 episodes in Medicare Advantage enrollees. Among both commercial insurance and Medicare Advantage enrollees, CJR implementation was associated with no meaningful changes in total episode expenditures, discharges to institutional post-acute care, or readmissions. We found no evidence for spillover effects of the CJR model on commercial insurance and Medicare Advantage patients, suggesting that alternative payment models targeting traditional Medicare patients may have limited effects on the cost and quality of care for patients outside of the traditional Medicare system.

Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propensity-score-matched control group using data from Guizhou province, China

BackgroundProvider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China.MethodsInpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases.ResultsAfter the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality.ConclusionsThe inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.

Impact of Radiation Oncology Alternative Payment Model on Community Cancer Centers.

An episode-based payment model, the Radiation Oncology Alternative Payment Model (RO-APM), is scheduled to go into effect in January 2022. This article investigates the effects of RO-APM on hospital-based and freestanding community centers. Historical Medicare data used to generate the RO-APM base rates were reviewed. A sensitivity analysis was performed to show how the RO-APM reimbursements compare with current reimbursements for commonly accepted treatment schedules and with current reimbursements at a large community practice. The RO-APM base rates represent a 2.2% decrease in overall Medicare reimbursement. Freestanding centers have historically billed at higher rates than hospital-based centers, however, and the RO-APM base rates represent a 6% decrease in global reimbursement for freestanding centers. The sensitivity analysis showed that, except for proton therapy, moderately hypofractionated treatment schedules will receive comparable reimbursement under RO-APM. Treatments using higher numbers of fractions of intensity-modulated radiation therapy or protons will see larger decreases in reimbursement. Application of the RO-APM base rates to the 2020 Medicare treatments in our health care network would result in small changes in expected reimbursement, but our sensitivity analysis indicated that Medicare reimbursement reductions could be as large as 23%. Compared with historical Medicare reimbursement, RO-APM base rates provide lower reimbursement for many common treatment scenarios, and this will have a larger effect on centers that use complex treatment techniques and longer fractionation schedules or have a large Medicare population.

Skilled Nursing Facility Participation in a Voluntary Medicare Bundled Payment Program: Association With Facility Financial Performance.

Model 3 of the Bundled Payments for Care Improvement (BPCI) is an alternative payment model in which an entity takes accountability for the episode costs. It is unclear how BPCI affected the overall skilled nursing facility (SNF) financial performance and the differences between facilities with differing racial/ethnic and socioeconomic status (SES) composition of the residents. The objective of this study was to determine associations between BPCI participation and SNF finances and across-facility differences in SNF financial performance. A longitudinal study spanning 2010-2017, based on difference-in-differences analyses for 575 persistent-participation SNFs, 496 dropout SNFs, and 13,630 eligible nonparticipating SNFs. Inflation-adjusted operating expenses, revenues, profit, and profit margin. BPCI was associated with reductions of $0.63 million in operating expenses and $0.57 million in operating revenues for the persistent-participation group but had no impact on the dropout group compared with nonparticipating SNFs. Among persistent-participation SNFs, the BPCI-related declines were $0.74 million in operating expenses and $0.52 million in operating revenues for majority-serving SNFs; and $1.33 and $0.82 million in operating expenses and revenues, respectively, for non-Medicaid-dependent SNFs. The between-facility SES gaps in operating expenses were reduced (differential difference-in-differences estimate=$1.09 million). Among dropout SNFs, BPCI showed mixed effects on across-facility SES and racial/ethnic differences in operating expenses and revenues. The BPCI program showed no effect on operating profit measures. BPCI led to reduced operating expenses and revenues for SNFs that participated and remained in the program but had no effect on operating profit indicators and mixed effects on SES and racial/ethnic differences across SNFs.

Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes

In 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer. To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM's first 3 years. Exploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before (January 2014 through June 2015) and after (July 2016 through December 2018) the start of the OCM. Participants included Medicare fee-for-service beneficiaries with cancer treated at these practices through June 2019. OCM participation. Total episode payments (Medicare spending for Parts A, B, and D, not including monthly payments for enhanced oncology services); utilization and payments for hospitalizations, emergency department (ED) visits, office visits, chemotherapy, supportive care, and imaging; quality (chemotherapy-associated hospitalizations and ED visits, timely chemotherapy, end-of-life care, and survival); and patient experiences. Among Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy, 483 319 beneficiaries (mean age, 73.0 [SD, 8.7] years; 60.1% women; 987 332 episodes) were treated at 201 OCM participating practices, and 557 354 beneficiaries (mean age, 72.9 [SD, 9.0] years; 57.4% women; 1 122 597 episodes) were treated at 534 comparison practices. From the baseline period, total episode payments increased from $28 681 for OCM episodes and $28 421 for comparison episodes to $33 211 for OCM episodes and $33 249 for comparison episodes during the intervention period (difference in differences, -$297; 90% CI, -$504 to -$91), less than the mean $704 Monthly Enhanced Oncology Services payments. Relative decreases in total episode payments were primarily for Part B nonchemotherapy drug payments (difference in differences, -$145; 90% CI, -$218 to -$72), especially supportive care drugs (difference in differences, -$150; 90% CI, -$216 to -$84). The OCM was associated with statistically significant relative reductions in total episode payments among higher-risk episodes (difference in differences, -$503; 90% CI, -$802 to -$204) and statistically significant relative increases in total episode payments among lower-risk episodes (difference in differences, $151; 90% CI, $39-$264). The OCM was not significantly associated with differences in hospitalizations, ED visits, or survival. Of 22 measures of utilization, 10 measures of quality, and 7 measures of care experiences, only 5 were significantly different. In this exploratory analysis, the OCM was significantly associated with modest payment reductions during 6-month episodes for Medicare beneficiaries receiving chemotherapy for cancer in the first 3 years of the OCM that did not offset the monthly payments for enhanced oncology services. There were no statistically significant differences for most utilization, quality, and patient experience outcomes.

Radiation Oncology Alternative Payment Model (RO-APM) Monte Carlo Simulations to Predict Financial Impact and Viability for Common Practice Types

The RO-APM will trial an episode-based payment schema over a five-year period starting in 2022. Practices were randomly selected for mandatory inclusion in the RO-APM. Participating departments have different case mixes, patients, and clinical practices that will dictate the relative impact of the RO-APM. It is our aim to create a highly versatile Monte Carlo model to simulate RO-APM effects on reimbursement and practice financial stability. In this study, we specifically focus on suburban and rural settings.Monte Carlo simulations were developed in Python to model the effects of the RO-APM model over the 5-year trial period. The model requires a patient population, distribution of delivery techniques, and fractionation patterns per delivery technique for each of the 16 defined disease sites. This information was gathered from two non-associated regional clinics: one that serves primarily a suburban population (SP) while the other serves a mixed SP and rural population (MP). All fixed and variable financial expenses were collected and included. The inclusion of extra administrative work for the RO-APM submission was also included using time-driven activity-based costing methods. Considering each clinic's Medicare population, statistical analyses of how the patient population, delivery technique, and fractionation patterns impact reimbursement for this subset population was performed. The RO-APM model was also compared to the fee-for-service model (FFS-M).Disease site distributions were within 7.5% absolute difference between the two clinics. The four most common disease sites treated averaged between the two clinics were lung (20.1%), breast (16.9%), prostate (12.6%), and head & neck (H&N) (9.9%). Fractionation patterns were within 3 fractions (fx) across all disease site modalities except for bladder (MP +19fx) and lung (MP +13fx) IMRT, and 3D H&N (MP +3.4fx). Medicare population was 30% and 33% for the SP and MP, respectively. The SP had a 10.4% ± 0.5% higher reimbursement rate in the RO-APM when compared to the FFS-M for its set of patients seen. The MP had a 5.0% ± 0.3% higher reimbursement rate in the RO-APM when compared to the FFS-M for its patient population. Investigating fractionation impact further, the correlation between the number of fractions across all sites/modalities and reimbursement rate increase for the RO-APM compared to the FFS-M was r (498) = -.45, P < 0.01, meaning that a lower number of fractions leads to a higher return in the RO-APM across multiple disease sites. Finally, additional administrative work in the RO-APM is expected to cost approximately 0.8% of the total reimbursement rate.In our analysis using extracted clinical patterns from two separate clinics, lower fractionation patterns can lead to a higher return on investment in the RO-APM compared to the FFS-M, demonstrating viability of the proposed RO-APM.

The Impact of Global Budgeting on the Efficiency of Healthcare under a Single-Payer System in Taiwan

Since 1995, a national health insurance (NHI) program has been in operation in Taiwan, which provides uniform comprehensive coverage. Forced by severe financial deficit, global budgeting reimbursement was adopted in the healthcare sector to control healthcare expenditures in 2002. A two-stage data envelopment analysis (DEA) approach was used to measure the efficiency of hospital resource allocation among stakeholders in Taiwan’s NHI system, and to further explore the changes in resource allocation after the introduction of a global budgeting payment scheme. The dataset was collected from the annual statistical reports of Taiwan’s Ministry of Health and Welfare (MOHW) and was used to estimate the efficiency of resource allocation in hospital-based healthcare services under global budgeting. In terms of efficiency during the period from 2003 to 2009, one-third of decision-making units (DMUs) improved their productivity in stage I, and seven out of the total of eighteen DMUs saw falls in financial efficiency in stage II. After global budgeting was implemented, there were significant positive impacts on the efficiency of hospital resource allocation in Taiwan. The two-stage DEA model for analyzing the effects of the global budgeting reimbursement system on productivity and financial efficiency represents a key decision-making tool for hospital administrators and policymakers.

Patient-reported Outcomes Among Vulnerable Populations in the Medicare Bundled Payments for Care Improvement Initiative.

The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative tested whether episode-based payment models could reduce Medicare payments without harming quality. Among patients with vulnerabilities, BPCI appeared to effectively reduce payments while maintaining the quality of care. However, these findings could overlook potential adverse patient-reported outcomes in this population. We surveyed beneficiaries with 4 characteristics (Medicare-Medicaid dual eligibility; dementia; recent institutional care; or racial/ethnic minority) treated at BPCI-participating or comparison hospitals for congestive heart failure, sepsis, pneumonia, or major joint replacement of the lower extremity. We estimated risk-adjusted differences in patient-reported outcomes between BPCI and comparison respondents, stratified by clinical episode and vulnerable characteristic. Patient care experiences during episodes of care and patient-reported functional outcomes assessed roughly 90 days after hospitalization. We observed no differences in self-reported functional improvement between BPCI and comparison respondents with vulnerable characteristics. Patient-reported care experience was similar between BPCI and comparison respondents in 11 of 15 subgroups of clinical episode and vulnerability. BPCI respondents with congestive heart failure, sepsis, and pneumonia were less likely to indicate positive care experiences than comparison respondents for at least 1 subgroup with vulnerabilities. As implemented by hospitals, BPCI Model 2 was not associated with adverse effects on patient-reported functional status among beneficiaries who may be vulnerable to reductions in care. Hospitals participating in heart failure, sepsis or pneumonia bundled payment episodes should focus on patient care experience while implementing changes in care delivery.

Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries

ObjectivesThe Centers for Medicare & Medicaid Services’ newly enacted Radiation Oncology Model (‘RO Model’) was designed to test the cost-saving potential of prospective episode-based payments for radiation treatment for 17...

Assessment of Determinants of Value in Carotid Endarterectomy

More than 150,000 carotid endarterectomies (CEAs) are performed in the United States, accounting for $2 to $3 billion, annually. How cost and spending and quality are related is not well understood but remains an essential component in maximizing value. We sought to identify the determinants of variability in hospital 90-day episode value for CEA. Medicare and private-payer admissions for CEA from January 2, 2014 to August 28, 2020 were linked to retrospective clinical registry data for 39 hospitals in Michigan. Hospital-specific, risk-adjusted 30-day composite complications (defined as reoperation, new neurologic deficit, myocardial infarction, additional procedures [including CEA or carotid artery stenting], readmission, and mortality) and 30-day risk-adjusted, price-standardized total episode payments were used to categorize hospitals into low or high value by defining the intersection between complications and spending. A total of 6595 patients across 39 hospitals were identified within both datasets (Fig 1). Patients at low-value hospitals had a higher rate of 30-day composite complications (17.9% vs 10.1%; P < .001), driven by a significantly higher rate of reoperations (3.0% vs 1.4%; P = .016), readmissions (10.7% vs 6.2%; P = .012), new neurologic deficits (4.6% vs 2.3%; P = .017), and mortality (1.6% vs 0.6%; P < .049). The mean total episode payment was $19,635 at low-value hospitals compared with $15,709 at high-value hospitals. The differences resulted from index hospitalization ($10,800 vs $9587; P = .002) professional ($3421 vs $2827; P < .001), readmission ($3011 vs $1826; P < .001), and post–acute care payments ($2335 vs $1486; P < .001; Fig 2). Tremendous variation exists in both quality and payments across hospitals performing CEA. We found little to no relationship between total episode spending and surgical quality, suggesting that improvements in value might be possible by decreasing total episode costs without affecting the surgical outcomes.Fig 2Bar graph showing costs stratified by payment types overall and for patients without complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The health care trajectories: a tool in bundle payment reflection

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)