CMS published its third annual evaluation of Models 2 to 4 of the Bundled Payments for Care Improvement program.
Commissioned by CMS and complied by the Lewin Group, the performance report examines Medicare claims and enrollment data, as well as post-acute care provider patient assessments, initiated through the second year of BPCI. The initiative spans late 2013 to late 2015.
The report calculates BPCI episode outcomes by comparing provider groups and episodes during baseline and intervention periods, with results differentiated by model and episode initiator. As of Oct. 1, Models 2, 3 and 4 comprised 306 hospitals, 550 skilled nursing facilities, 60 home health agencies and 218 physician group practices. Approximately 284,700 episodes of care were initiated during the first two years of the BPCI initiative.
The report comes as President Donald Trump's administration aims to cancel or scale back major bundled payment initiatives.
Here are five key findings from the report.
1. During the first two years of the BPCI model, Medicare payments for major joint replacement of the lower extremity fell $1,273. This represents a 4.5 percent decrease from the baseline, or without BPCI.
2. The analysis found few statistically significant quality changes during the first two years of the BPCI initiative under Model 2. Model 2 includes inpatient hospital stay, concurrent professional services and Medicare Part A- and Part B-covered services.
3. Medicare saved $970 in congestive heart failure spending per episode, reflecting a 3.6 percent decrease from the baseline.
4. Unplanned 90-day readmissions after SNF admission did not fall as much in BPCI SNFs as in comparison SNFs.
5. While data show BPCI led to some improvements, researchers concluded it is unclear if the changes were directly linked to BPCI.
"The mixed methods evaluation we have employed indicates that BPCI participants have responded to BPCI incentives, but there are relatively few instances in which these responses significantly changed key outcomes," they wrote. "Because of the large number of situations encompassed under the initiative, including the selective and heterogeneous group of participants and limited and varied experience of participants, it is challenging to reach conclusions about the overall impact of BPCI."
For the full report, click here.
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