Evidence map›Paper›PMID 33948796›Full record

ArticleJournal of general internal medicine2022

Predictors of Success in the Bundled Payments for Care Improvement Program.

Jonathan D Wolfe, Arnold M Epstein, Jie Zheng, E John Orav, Karen E Joynt Maddox

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jonathan D WolfeCardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Arnold M EpsteinDivision of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Jie ZhengDepartment of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
E John OravDivision of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Karen E Joynt MaddoxCardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA. kjoyntmaddox@wustl.edu.ORCID 0000-0003-3779-8653

Funding

The Impact of Bundled Payments for Cardiopulmonary Disease on High-Risk PopulationsR01HL143421 · NHLBI · WASHINGTON UNIVERSITY · PI JOYNT MADDOX, KAREN ELLEN · 2019 to 2022
$3.1M
NHLBI NIH HHS 1R01HL143421-01A1NHLBI NIH HHS R01 HL143421
6 · The paper itself

Abstract

backgroundHospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program were incented to reduce Medicare payments for episodes of care.

objectiveTo identify factors that influenced whether or not hospitals were able to save in the BPCI program, how the cost of different services changed to produce those savings, and if "savers" had lower or decreased quality of care.

designRetrospective cohort study.

participantsBPCI-participating hospitals. MAIN MEASURES: We designated hospitals that met the program goal of decreasing costs by at least 2% from baseline in average Medicare payments per 90-day episode as "savers." We used regression models to determine condition-level, patient-level, hospital-level, and market-level characteristics associated with savings. KEY

resultsIn total, 421 hospitals participated in BPCI, resulting in 2974 hospital-condition combinations. Major joint replacement of the lower extremity had the highest proportion of savers (77.6%, average change in payments -$2235) and complex non-cervical spinal fusion had the lowest (22.2%, average change +$8106). Medical conditions had a higher proportion of savers than surgical conditions (11% more likely to save, P=0.001). Conditions that were mostly urgent/emergent had a higher proportion of savers than conditions that were mostly elective (6% more likely to save, P=0.007). Having higher than median costs at baseline was associated with saving (OR: 3.02, P<0.001). Hospitals with more complex patients were less likely to save (OR: 0.77, P=0.003). Savings occurred across both inpatient and post-acute care, and there were no decrements in clinical care associated with being a saver.

conclusionsCertain conditions may be more amenable than others to saving under bundled payments, and hospitals with high costs at baseline may perform well under programs which use hospitals' own baseline costs to set targets. Findings may have implications for the BPCI-Advanced program and for policymakers seeking to use payment models to drive improvements in care.

Indexed as

MedicarePatient Care BundlesAgedHospitalsHumansRetrospective StudiesSubacute CareUnited Statescost-effectivenessfinancial incentiveshealthcare quality improvementhealth policyhealth services research

Identifiers

PMID33948796
PMCPMC8858349

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.