CMS has teamed up with the Altarum Institute to debunk the argument by Elliot Fisher, MD, director of Lebanon, N.H.-based Dartmouth Institute for Health Policy and Clinical Practice, that CMS' Bundled Payments for Care Initiative increases procedure volume.
The CMS-Altarum study is a direct response to an editorial published last September in JAMA.The editorial disputed the findings of another study in the same issue of JAMA thatfound Medicare payments for lower extremity joint replacement episodes decreased more in BPCI hospitals than non-BPCI hospitals during the first 21 months of the program. The dissenting editorial claimed there was a significant increase in procedure volume between the baseline and performance years for hospitals participating in BPCI compared to non-BPCI hospitals, and that this may have increased overall total spend, rather than decreasing it. The editorial suggested the BPCI program could be incentivizing providers to perform more procedures.
To investigate this claim, CMS and Altarum Institute analyzed Medicare Part A claims and counted major lower joint replacement procedures at all hospitals between 2011 and 2015. Any hospitals with 11 or fewer procedures in any year between 2011 or 2015 were thrown out. Researchers then used a difference-in-differences model to compare the average change in joint replacement procedure volume between BPCI hospitals and non-BPCI hospitals. They also compared their findings with demographic and market trends associated with increases in joint replacement procedures.
The CMS-Altarum study suggests facilities that did experience an increase in procedure volume during BPCI performance years did so because of market forces, not the program. In some cases, it was due to hospital consolidation, in others an increase in procedure volume was due to a growth in the Medicare population.
"[O]ur study definitively disputes any assertion that the BPCI-participating hospitals contributed to a higher volume of procedures as a result of that participation," the authors concluded. "In fact, the opposite is true. The rate of increase in the volume of procedures was significantly lower than in the rest of the country. These findings point to the potential of bundled payment to improve quality and lower costs of care while maintaining or lowering the volume of the episodes of care."
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