Abstract
Objective
To investigate differences in facility characteristics, patient characteristics, and
outcomes between skilled nursing facilities (SNFs) that participated in Medicare’s
voluntary Bundled Payments for Care Improvement (BPCI) initiative and nonparticipants,
prior to BPCI.
Design
Retrospective, cross-sectional comparison of BPCI participants and nonparticipants.
Setting
SNFs.
Participants
All Medicare-certified SNFs (N=15,172) and their 2011-2012 episodes of care for chronic
obstructive pulmonary disease, congestive heart failure, femur and hip/pelvis fracture,
hip and femur procedures, lower extremity joint replacement, and pneumonia (N=873,739).
Interventions
Participation in a bundled payment program that included taking financial responsibility
for care within a 90-day episode.
Main Outcome Measures
This study investigates the characteristics of bundled payment participants and their
patient characteristics and outcomes relative to nonparticipants prior to BPCI, to
understand the implications of a broader implementation of bundled payments.
Results
SNFs participating in BPCI were more likely to be in urban areas (80.8%-98.4% vs 69.5%)
and belong to a chain or system (73.8%-85.5% vs 55%), and were less likely to be located
in the south (13.1%-20.2% vs 35.4%). Quality performance was similar or higher in
most cases for SNFs participating in BPCI relative to nonparticipants. In addition,
BPCI participants admitted higher socioeconomic status patients with similar clinical
characteristics. Initial SNF length of stay was shorter and hospital readmission rates
were lower for BPCI patients compared to nonparticipant patients.
Conclusions
We found that SNFs participating in the second financial risk-bearing phase of BPCI
represented a diversity of SNF types, regions, and levels of quality and the results
may provide insight into a broader adoption of bundled payment for postacute providers.
Keywords
List of abbreviations:
ADL (activities of daily living), BPCI (Bundled Payments for Care Improvement), MS-DRG (Medicare Severity Diagnosis-Related Group), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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References
- Bundled Payment for Care Improvement (BPCI) Initiative: general information.(Available at:) (Accessed February 12, 2018)
- BPCI Model 3: retrospective post acute care only.(Available at:) (Accessed: February 12, 2018)
Kolata G. Method of study is criticized in group's health policy tests. New York Times. February 2, 2014; A1.
- Revamping provider payment in Medicare.Forum Health Econ Policy. 2015; 18: 137-149
- Medicare's new bundled payments: design, strategy, and evolution.JAMA. 2016; 315: 131-132
- BPCI Advanced.(Available at:) (Accessed February 13, 2018)
Dummit L, Murrafo G, Marshall J, et al; The Lewin Group. CMS Bundled Payments for Care Improvement (BPCI) initiative models 2-4: year 3 evaluation and monitoring annual report. Available at: https://downloads.cms.gov/files/cmmi/bpci-models2-4yr3evalrpt-app.pdf. Accessed November 1, 2017.
- Medicare's bundled payment initiative: most hospitals are focused on a few high-volume conditions.Health Aff. 2015; 34: 371-380
- Provider of services current files.(Available at:) (Accessed March 17, 2017)
- Census regions and divisions of the United States.(Available at:) (Accessed February 15, 2018)
- LTCfocus facility data, 2013.(Available at:) (Accessed March 1, 2018)
- Nursing Home Compare, 2016.(Available at:) (Accessed February 15, 2018)
- Quality improvement under nursing home compare: the association between changes in process and outcome measures.Med Care. 2013; 51: 582-588
- Does information matter? Competition, quality, and the impact of nursing home report cards.Health Serv Res. 2011; 46: 1698-1719
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- RCS-I model calculation worksheet for SNFs.(Available at:) (Accessed March 1, 2018)
- Functional improvement among short-stay nursing home residents in the MDS 3.0.J Am Med Dir Assoc. 2015; 16: 470-474
- Data by region.(Available at:) (Acccessed January 15, 2018)
Gronniger T, Fiedler M, Patel K, Adler K, Ginsburg PB. How should the Trump administration handle Medicare’s new bundled payment programs? Health Affairs Blog, April 10, 2017. https://www.healthaffairs.org/do/10.1377/hblog20170410.059551/full/.
Article info
Publication history
Published online: October 03, 2018
Footnotes
Supported by the National Institute on Aging (grant no. R01AG046838).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
