CMS program participation and policy evaluation without administrative data: a case study on Bundled Payments for Care Improvement (BPCI) initiative

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.

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Examining Disclosure Risk and Data Utility: An Administrative Data Case Study

International Journal of Digital Curation ◽

10.2218/ijdc.v9i1.297 ◽

2014 ◽

Vol 9 (1) ◽

pp. 12-24

Author(s):

Michael Comerford

Keyword(s):

Administrative Data ◽

Real World ◽

Data Sources ◽

Sufficient Data ◽

Ethical Challenges ◽

Data Utility ◽

Disclosure Risk ◽

Individual Privacy

The plethora of new data sources, combined with a growing interest in increased access to previously unpublished data, poses a set of ethical challenges regarding individual privacy. This paper sets out one aspect of those challenges: the need to anonymise data in such a form that protects the privacy of individuals while providing sufficient data utility for data users. This issue is discussed using a case study of Scottish Government’s administrative data, in which disclosure risk is examined and data utility is assessed using a potential ‘real-world’ analysis.

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Multi-province epidemiological research using linked administrative data: a case study from Canada.

International Journal for Population Data Science ◽

10.23889/ijpds.v3i3.443 ◽

2018 ◽

Vol 3 (3) ◽

Author(s):

Amanda Leanne Butler ◽

Mark Smith ◽

Wayne Jones ◽

Carol E Adair ◽

Simone Vigod ◽

...

Keyword(s):

Information Systems ◽

Administrative Data ◽

Research Process ◽

Health Data ◽

Provincial Government ◽

Data Systems ◽

Administrative Health Data ◽

Healthcare Data ◽

Research Activities

BackgroundCanada has a publicly-funded universal healthcare system with information systems managed by 13 different provinces and territories. This context creates inconsistencies in data collection and challenges for research or surveillance conducted at the national or multi-jurisdictional level. ObjectiveUsing a recent Canadian research project as a case study, we document the strengths and challenges of using administrative health data in a multi-jurisdictional context. We discuss the implications of using different health information systems and the solutions we adopted to deal with variations. Our goal is to contribute to better understanding of these challenges and the development of a more integrated and harmonized approach to conducting multi-jurisdictional research using administrative data. Context and ModelUsing data from five separate provincial healthcare data systems, we sought to create and report on a set of provincially-comparable mental health and addiction services performance indicators. In this paper, we document the research process, challenges, and solutions. Finally, we conclude by making recommendations for investment in national infrastructure that could help cut costs, broaden scope, and increase use of administrative health data that exists in Canada. ConclusionCanada has an incredible wealth of administrative data that resides in 13 territorial and provincial government systems. Navigating access and improving comparability across these systems has been an ongoing challenge for the past 20 years, but progress is being made. We believe that with some investment, a more harmonized and integrated information network could be developed that supports a broad range of surveillance and research activities with strong policy and program implications.

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Developing Markov Models From Real-World Data: A Case Study of Heart Failure Modeling Using Administrative Data

Value in Health ◽

10.1016/j.jval.2020.02.012 ◽

2020 ◽

Vol 23 (6) ◽

pp. 743-750

Author(s):

Praveen Thokala ◽

Peter Dodd ◽

Hassan Baalbaki ◽

Alan Brennan ◽

Simon Dixon ◽

...

Keyword(s):

Heart Failure ◽

Administrative Data ◽

Real World ◽

Markov Models ◽

Real World Data ◽

World Data ◽

Failure Modeling

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Policy Evaluation of the Farmland, Water and Environmental Conservation Improvement Scheme: A Case Study of Shiga Prefecture

Journal of Rural Problems ◽

10.7310/arfe.53.72 ◽

2017 ◽

Vol 53 (2) ◽

pp. 72-83 ◽

Cited By ~ 2

Author(s):

Midori Komiyama ◽

Junichi Ito

Keyword(s):

Policy Evaluation ◽

Environmental Conservation ◽

Improvement Scheme

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b6.bjj-2019-1369 ◽

2020 ◽

Vol 102-B (6_Supple_A) ◽

pp. 19-23 ◽

Cited By ~ 5

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.

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