Impact of Bundled Payment Care Improvement Initiative on Healthcare Expenditure in Major Bowel Procedures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Robert N. Goldstone ◽  
Jianying Zhang ◽  
Caitlin Stafford ◽  
Liliana Bordeianou ◽  
Hiroko Kunitake ◽  
...  
Keyword(s):  
Healthcare Expenditure ◽  
Bundled Payment ◽  
Care Improvement

scholarly journals Real-Time Identification of Patients Included in the CMS Bundled Payment Care Improvement (BPCI) Program

2020 ◽  
Vol 41 (S1) ◽  
pp. s367-s368
Author(s):  
Michael Korvink ◽  
John Martin ◽  
Michael Long
Keyword(s):  
Performance Evaluation ◽  
Real Time ◽  
Naive Bayes ◽  
Naïve Bayes ◽  
Care Providers ◽  
Meta Model ◽  
Bundled Payment ◽  
Clinical Cohort ◽  
Real Time Identification ◽  
Care Improvement

Background: The Bundled Payment Care Improvement Program is a CMS initiative designed to encourage greater collaboration across settings of care, especially as it relates to an initial set of targeted clinical episodes, which include sepsis and pneumonia. As with many CMS incentive programs, performance evaluation is retrospective in nature, resulting in after-the-fact changes in operational processes to improve both efficiency and quality. Although retrospective performance evaluation is informative, care providers would ideally identify a patient’s potential clinical cohort during the index stay and implement care management procedures as necessary to prevent or reduce the severity of the condition. The primary challenges for real-time identification of a patient’s clinical cohort are CMS-targeted cohorts are based on either MS-DRG (grouping of ICD-10 codes) or HCPCS coding—coding that occurs after discharge by clinical abstractors. Additionally, many informative data elements in the EHR lack standardization and no simple and reliable heuristic rules can be employed to meaningfully identify those cohorts without human review. Objective: To share the results of an ensemble statistical model to predict patient risks of sepsis and pneumonia during their hospital (ie, index) stay. Methods: The predictive model uses a combination of Bernoulli Naïve Bayes natural language processing (NLP) classifiers, to reduce text dimensionality into a single probability value, and an eXtreme Gradient Boosting (XGBoost) algorithm as a meta-model to collectively evaluate both standardized clinical elements alongside the NLP-based text probabilities. Results: Bernoulli Naïve Bayes classifiers have proven to perform well on short text strings and allow for highly explanatory unstructured or semistructured text fields (eg, reason for visit, culture results), to be used in a both comparative and generalizable way within the larger XGBoost model. Conclusions: The choice of XGBoost as the meta-model has the benefits of mitigating concerns of nonlinearity among clinical features, reducing potential of overfitting, while allowing missing values to exist within the data. Both the Bayesian classifier and meta-model were trained using a patient-level integrated dataset extracted from both a patient-billing and EHR data warehouse maintained by Premier. The data set, joined by patient admission-date, medical record number, date of birth, and hospital entity code, allows the presence of both the coded clinical cohort (derived from the MS-DRG) and the explanatory features in the EHR to exist within a single patient encounter record. The resulting model produced F1 performance scores of .65 for the sepsis population and .61 for the pneumonia population.Funding: NoneDisclosures: None

scholarly journals Early Effects of Medicareʼs Bundled Payment for Care Improvement Program for Lumbar Fusion

Spine ◽  
2018 ◽  
Vol 43 (10) ◽  
pp. 705-711 ◽  
Author(s):  
Brook I. Martin ◽  
Jon D. Lurie ◽  
Farrokh R. Farrokhi ◽  
Kevin J. McGuire ◽  
Sohail K. Mirza
Keyword(s):  
Lumbar Fusion ◽  
Improvement Program ◽  
Bundled Payment ◽  
Early Effects ◽  
Care Improvement

Medicare bundles for arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 119-125
Author(s):  
Bryan D. Springer ◽  
Jordan McInerney
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Drop Out ◽  
Retention Rates ◽  
Fee For Service ◽  
Target Price ◽  
High Performing ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Care Improvement

Aims There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service. Methods Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). With rebasing of Target Prices in 2020 and opportunity for participants to drop out, we compared retention rates of hospitals and physician groups enrolled at the onset of BPCI Advanced with current enrolment in 2020. Results At its peak in July 2015, 342 acute care hospitals and physician groups participated in Lower Extremity Joint Replacement (LEJR) in BPCI Classic. At its peak in March 2019, 534 acute care hospitals and physician groups participated in LEJR in BPCI Advanced. In January 2020, only 14.5% of legacy hospitals and physician groups opted to stay in BPCI Advanced for LEJR. Analysis of Target Price factors by legacy hospitals during both programmes demonstrates that participants in BPCI Classic received larger negative adjustments on the Target Price than non-legacy hospitals. Conclusion BPCI Advanced provides little opportunity for a reduction in cost to offset a reduced Target Price for efficient providers, as made evident by the 85.5% withdrawal rate for BPCI Advanced. Efficient providers in BPCI Advanced are challenged by the programme’s application of trend and efficiency factors that presumes their cost reduction can continue to decline at the same rate as non-efficient providers. It remains to be seen if reverting back to Medicare fee for service will support the same level of care and quality achieved in historical bundled payment programmes. Cite this article: Bone Joint J 2021;103-B(6 Supple A):119–125.

2020 John N. Insall Award: Removal of total knee arthroplasty from the inpatient-only list adversely affects bundled payment programmes

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 19-23 ◽  
Author(s):  
Michael Yayac ◽  
Nicholas Schiller ◽  
Matthew S. Austin ◽  
P. Maxwell Courtney
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Hospital Inpatient ◽  
Target Price ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Medicare Patients ◽  
Total Knee ◽  
Care Improvement ◽  
The Impact

Aims The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. Methods We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as ‘outpatient’ and ‘inpatient’ TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018. Results Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme. Conclusions Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19–23.

Age and Frailty Influence Hip and Knee Arthroplasty Reimbursement in a Bundled Payment Care Improvement Initiative

2019 ◽  
Vol 34 (7) ◽  
pp. S80-S83 ◽  
Author(s):  
Andrew M. Pepper ◽  
David Novikov ◽  
Zlatan Cizmic ◽  
John T. Barrett ◽  
Michael Collins ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Bundled Payment ◽  
Hip And Knee Arthroplasty ◽  
Care Improvement

What Are the Cost Drivers for the Major Bowel Bundled Payment Care Improvement Initiative?

2020 ◽  
Vol 64 (1) ◽  
pp. 112-118
Author(s):  
Rocco Ricciardi ◽  
Marilyn A. Moucharite ◽  
Caitlin Stafford ◽  
Guy Orangio ◽  
Patricia L. Roberts
Keyword(s):  
Cost Drivers ◽  
Bundled Payment ◽  
Care Improvement ◽  
The Cost

scholarly journals Overlap between Medicare’s Voluntary Bundled Payment and Accountable Care Organization Programs

2019 ◽  
Vol 15 (6) ◽  
pp. 356-358 ◽  
Author(s):  
Amol S Navathe ◽  
Claire Dinh ◽  
Sarah E Dykstra ◽  
Rachel M Werner ◽  
Joshua M Liao
Keyword(s):  
Policy Implications ◽  
Care Organization ◽  
Accountable Care ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Medicare Data ◽  
Shared Savings ◽  
Care Improvement ◽  
Medicare Shared Savings Program ◽  
A Share

Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BPCI episodes, while overlap as a share of all bundled payment patients increased from 19% to 27%. Overlap from the perspectives of both ACO and bundled payments varied by specific episode. In the first description of overlap between ACOs and bundled payments, one in every ten MSSP patients received care under BPCI by the end of our study period, whereas more than one in every four patients receiving care under BPCI were also attributed to MSSP. Policymakers should consider strategies to address the clinical and policy implications of increasing payment model overlap.

scholarly journals Race, Bundled Payment Policy, and Discharge Destination After TKA: The Experience of an Urban Academic Hospital

2018 ◽  
Vol 9 ◽  
pp. 215145931880322 ◽  
Author(s):  
Michele Fang ◽  
Eric Hume ◽  
Said Ibrahim
Keyword(s):  
African American ◽  
Elective Surgery ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Adverse Outcomes ◽  
Discharge Destination ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Care Improvement ◽  
White Patients

Background: Total knee arthroplasty (TKA) provides good clinical outcomes for the treatment of end-stage osteoarthritis; however, discharge destination after TKA has major implications on postoperative adverse outcomes and readmissions. With the initiation of Bundled Payments for Care Improvement (BPCI), it is unclear how racial disparities in discharge destination after TKA will be affected by the new bundled payment for TKA. Methods: Bundled Payments for Care Improvement was implemented in July 01, 2014, at the University of Pennsylvania. We compared differences during early implementation (July 1, 2014, to, March 30, 2016) and during late policy implementation (April 1, 2016, to February 28, 2017) in patient characteristics (including race: African American [AA], white, and other race), discharge destination (skilled nursing facility [SNF], inpatient rehabilitation facility, home, home with home health, or other), and outcomes. Results: We identified 2276 patients who underwent TKA (43.8% AA, 48.2% white, and 8.0% other race). African American patients were more likely to be discharged to SNF as opposed to home than white patients both during the early BPCI (AA: 53.0%, n = 320; white: 32.4%, n = 210, P < .05) and late BPCI implementation (AA: 44.4%, n = 169, white: 26.9%, n = 120, P < .05), though all races showed trends to decreasing SNF use during the late BPCI implementation. Discussion: There were no significant differences in readmissions, length of stay, mortality, or intensive care unit days during early and late implementation of BPCI or when AA patients were compared to white patients. Conclusion: We found no significant changes in racial variations in discharge destination and outcomes after elective TKA. Bundled Payments for Care Improvement has encouraged better preoperative preparation of patients and discharge planning; however, payment reforms alone might not be sufficient to address variation in post-op management following elective surgery.

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