Consistent with numerous studies, researchers have found there is no evidence that participation in Medicare's Bundled Payment for Care Improvement program drives volume increases and higher costs, according to a new study from the Altarum Institute.
Those findings back up an initial study published in the Journal of the American Medical Association examining the effects of BPCI for participating hospitals focusing on lower extremity joint replacements.
Compared to a matched cohort, the JAMA study concluded that post-acute care costs had decreased from baseline and that quality outcomes had remained the same. While the volume of procedures increased in the performance year as compared to baseline for both participants and the matched cohort, the authors reported that the somewhat greater increase observed among the BPCI participants was not significantly greater.
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An accompanying editorial by Elliott Fisher cast doubt on the findings by focusing on the differences in procedure volumes between the intervention and matched cohorts, as well as the increase in volume in the intervention cohort. These increases, the author argued, were significant and, when taken into account, point to a net increase in Medicare spend and supports the argument that procedure-focused bundled payment programs may encourage the production of unnecessary procedures.
But the Altarum researchers contend that Fisher never took into account the potential for the volume of the procedures at the participating hospitals to reflect differences in the underlying count of Medicare beneficiaries in the local area -- nor the differences in regional prevalence rates for these types of procedures.
The Altarum study shows that the initial group of BPCI participants, those that went into the program in October 2013 and January 2014, had a rate of increase between baseline and performance years that was significantly lower than the national rate. In fact, for that group, the volume of procedures in 2015 was lower than in 2014.
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The second group of facilities, those that started in early 2015, experienced a larger increase in volume between 2012 and 2015, although none of that increase can be attributed to the effects of the BPCI program, said Altarum, since none of these facilities was enrolled in BPCI until the beginning of 2015.
An investigation of the facilities that experienced significant increases reveals the effect of common market forces, such as the growth in the Medicare population or the number of hospitals in the region, Altarum found.
Those factors, all taken together, affect the frequency with which the procedures are performed. Nationally, the procedure rate varied in 2015 from 57 to 434 per 1000 Medicare beneficiaries, averaging 144. The majority of the BPCI-participating facilities are in hospital referral regions with prevalence rates at or below the national average, and the rate of growth for these procedures in the regions that contain BPCI participants was not different from tha of the national average.
The findings are consistent with previous studies, and also with studies showing that non-whites and beneficiaries enrolled in Medicare Advantage plans have fewer of these types of procedures.
Twitter: @JELagasse