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.

Spending Among Patients With Cancer in the First 2 Years of Accountable Care Organization Participation

2018 ◽  
Vol 36 (29) ◽  
pp. 2955-2960 ◽  
Author(s):  
Miranda B. Lam ◽  
Jose F. Figueroa ◽  
Jie Zheng ◽  
E. John Orav ◽  
Ashish K. Jha
Keyword(s):  
Cancer Diagnosis ◽  
Geographic Region ◽  
Care Utilization ◽  
Care Organization ◽  
Accountable Care ◽  
Patients With Cancer ◽  
Cancer Types ◽  
Shared Savings ◽  
Heath Care ◽  
Medicare Shared Savings Program

Purpose Spending on patients with cancer can be substantial and has continued to increase in recent years. Accountable Care Organizations (ACOs) are arguably the most important national experiment to control health care spending, yet how ACOs are managing patients with cancer diagnoses is largely unknown. We aimed to determine whether practices that became ACOs had changes in overall or cancer-specific spending among patients with cancer. Methods Using 2011 to 2015 national Medicare claims, practices that became part of ACOs were identified and matched to non-ACO practices within the same geographic region. We calculated total and category-specific annual spending per beneficiary as well as spending for and utilization of emergency departments, inpatient admissions, hospice, chemotherapy, and radiation therapy. A difference-in-differences model was used to examine changes in spending and utilization associated with ACO contracts in the Medicare Shared Savings Program for beneficiaries with cancer. Results We found that the introduction of ACOs had no meaningful impact on overall spending in patients with cancer (−$308 per beneficiary in ACOs v −$319 in non-ACOs; difference, $11; 95% CI, −$275 to $297; P = .94). We found no changes in total spending in patients within any of the 11 different cancer types examined. Finally, changes in spending and utilization did not meaningfully differ between ACO and non-ACO patients within various categories, including cancer-specific categories. Conclusion Compared with patients with cancer treated at non-ACO practices, being a patient with a cancer diagnosis in a Medicare ACO is not associated with significantly reduced spending or heath care utilization. The introduction of ACOs does not seem to have had any meaningful effect on spending or utilization for patients with a cancer diagnosis.

scholarly journals Early effect of Medicare Shared Savings Program accountable care organization participation on prostate cancer care

Cancer ◽  
2017 ◽  
Vol 124 (3) ◽  
pp. 563-570 ◽  
Author(s):  
Tudor Borza ◽  
Samuel R. Kaufman ◽  
Phyllis Yan ◽  
Lindsey A. Herrel ◽  
Amy N. Luckenbaugh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Care ◽  
Accountable Care Organization ◽  
Care Organization ◽  
Accountable Care ◽  
Early Effect ◽  
Shared Savings ◽  
Medicare Shared Savings Program

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.

scholarly journals Association Between Hospital Participation in Medicare Shared Savings Program Accountable Care Organizations and Readmission Following Major Surgery

2019 ◽  
Vol 269 (5) ◽  
pp. 873-878 ◽  
Author(s):  
Tudor Borza ◽  
Mary K. Oerline ◽  
Ted A. Skolarus ◽  
Edward C. Norton ◽  
Justin B. Dimick ◽  
...  
Keyword(s):  
Accountable Care Organizations ◽  
Major Surgery ◽  
Accountable Care ◽  
Shared Savings ◽  
Medicare Shared Savings Program
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