ArticleJournal of the American Geriatrics Society2021
Savings and outcomes under Medicare's bundled payments initiative for skilled nursing facilities.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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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.
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Who cites it
6 citing papers in PubMed.
- The extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment.Journal of the American Geriatrics Society · 2024Article
- Care delivery approaches and perceived barriers to improving quality of care: A national survey of skilled nursing facilities.Journal of the American Geriatrics Society · 2023Article
- Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries.JAMA network open · 2023Article
- The Association Between Facility Affiliations and Revenue Generation in Skilled Nursing Facilities - An Exploratory Study.Journal of multidisciplinary healthcare · 2023Article
- Medicare's Bundled Payments For Care Improvement Advanced Model: Impact On High-Risk Beneficiaries.Health affairs (Project Hope) · 2022Article
- Lessons from Medicare's Bundled Payments for Care Improvement initiative for postacute care.Journal of the American Geriatrics Society · 2021Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundModel 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown.
methodsRetrospective cohort study using Medicare claims from 2012 to 2017. We used an interrupted time-series design to compare participating vs matched control SNFs on total 90-day Medicare payments and payment components (initial SNF stay, readmissions, and outpatient/clinician), case mix (volume, proportion Medicaid, proportion black, number of comorbidities), and clinical outcomes (90-day readmission, mortality and healthy days at home, and length of initial SNF stay), overall and among key subgroups with frailty or dementia, for 47 of the 48 conditions in the program (excluding major lower extremity joint replacement).
resultsOur sample included 1001 participating and 3873 matched control SNFs. At baseline, total Medicare institutional payments were increasing at BPCI SNFs at a rate of $121 per episode per quarter; during the intervention period, payments decreased at a rate of -$398/episode/quarter. Among controls, payments were stable in the baseline period (+$17/episode/quarter) but decreased at -$424/episode/quarter during the intervention period, yielding a nonsignificant difference in slope changes of -$79/episode/quarter (95% confidence interval [CI] -$188, $31, p = 0.16). However, among patients with frailty, spending declined by $620/episode/quarter in the BPCI group, compared with $330/episode/quarter in the non-BPCI group, for a difference in slope changes of -$289 (95% CI -$482, -$96, p = 0.003). There were no differences in the change in slopes in case selection or clinical outcomes overall or in any clinical subgroup.
conclusionsSNF participation in BPCI was associated with no overall differential change in total Medicare payments per episode, case selection, or clinical outcomes. Exploratory analyses revealed a decrease in Medicare payments in patients with frailty that may warrant further study.
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