Impact of Medicare’s Bundled Payments Initiative on Patient Selection, Payments, and Outcomes for Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting
| Autor: | E. John Orav, Christian McNeely, Jie Zheng, Karen E. Joynt Maddox |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Percutaneous Databases Factual Bypass grafting media_common.quotation_subject medicine.medical_treatment Clinical Decision-Making Coronary Artery Disease Medicare Patient Readmission Article Percutaneous Coronary Intervention Humans Medicine cardiovascular diseases Coronary Artery Bypass Selection (genetic algorithm) Aged media_common Aged 80 and over business.industry Patient Selection Bundled payments Percutaneous coronary intervention Length of Stay Middle Aged Payment United States Outcome and Process Assessment Health Care Treatment Outcome surgical procedures operative Insurance Health Reimbursement Emergency medicine Female Cardiology and Cardiovascular Medicine business Medicaid Patient Care Bundles |
| Zdroj: | Circ Cardiovasc Qual Outcomes |
| ISSN: | 1941-7705 1941-7713 |
| Popis: | Background: The Center for Medicare and Medicaid Innovation launched the Bundled Payments for Care Initiative (BPCI) in 2013. Its effect on payments and outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is unknown. Methods and Results: We used Medicare inpatient files to identify index admissions for PCI and CABG from 2013 through 2016 at BPCI hospitals and matched control hospitals and difference in differences models to compare the 2 groups. Our primary outcome was the change in standardized Medicare-allowed payments per 90-day episode. Secondary outcomes included changes in patient selection, discharge to postacute care, length of stay, emergency department use, readmissions, and mortality. Forty-two hospitals joined BPCI for PCI and 46 for CABG. There were no differential changes in patient selection between BPCI and control hospitals. Baseline Medicare payments per episode for PCI were $20 164 at BPCI hospitals and $19 955 at control hospitals. For PCI, payments increased at both BPCI and control hospitals during the intervention period, such that there was no significant difference in differences (BPCI hospitals +$673, P =0.048; control hospitals +$551, P =0.022; difference in differences $122, P =0.768). For CABG, payments at both BPCI and control hospitals decreased during the intervention period (BPCI baseline, $36 925, change −$2918, P P P =0.730). For both PCI and CABG, BPCI participation was not associated with changes in mortality, readmissions, or length of stay. Among BPCI hospitals, emergency department use differentially increased for patients undergoing PCI and decreased for patients undergoing CABG. Conclusions: Participation in episode-based payment for PCI and CABG was not associated with changes in patient selection, payments, length of stay, or clinical outcomes. |
| Databáze: | OpenAIRE |
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