ArticleJAMA network open2024
Medical and Surgical Episodes Among Hospital Participants in the Bundled Payments for Care Improvement-Advanced Program.
Article in JAMA network open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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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.
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.
Who cites it
6 citing papers in PubMed.
- Value operating system: a practical framework to measure outcomes-per-cost at the episode level.BMJ open quality · 2026Article
- Value-Based Medicine in the Management of Abdominal Aortic Aneurysms.Journal of the American Heart Association · 2026Review
- Establishing criteria for emergency department-based episode of care definitions: a modified Delphi study.BMJ open · 2026Article
- Bundled Payment Programs and Changes in Practice Patterns and Episode Spending in Major Gastrointestinal Surgery.Health services research · 2026Article
- Savings Associated With Bundled Payments for Outpatient Spine Surgery Among Medicare Beneficiaries.JAMA health forum · 2025Article
- Physician and Hospital Performance in Medicare's Updated Bundled-Payment Model for Joint Replacement.JAMA health forum · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
Importance: Hospital participation in the Bundled Payments for Care Improvement-Advanced (BPCI-A) initiative has been associated with modest savings and stable clinical outcomes overall, but it is unknown whether the program performs differently for medical and surgical or procedural (henceforth, surgical) episodes. Objective: To assess the association of BPCI-A participation with Medicare spending and clinical outcomes for medical and surgical episodes. Design, Setting, and Participants: This retrospective difference-in-differences cohort study utilized 100% Medicare fee-for-service inpatient claims for episodes initiated between January 1, 2017, and September 30, 2019, and included 90 days of follow-up. The setting was hospitals participating in BPCI-A and matched nonparticipant hospitals. Participants included Medicare beneficiaries admitted for medical or surgical episodes. Exposure: BPCI-A participation, beginning in 2018. Main Outcomes and Measures: Changes in 90-day Medicare payments and clinical outcomes (readmissions, mortality, healthy days at home). Results: The final sample included 2 895 878 episodes; 1 618 172 (55.9%) were female, 324 186 (11.2%) people under age 65 years, 1 354 246 (46.8%) between 65 and 80 years of age, and 1 217 446 (42.0%) over 80 years of age. Patient characteristics at BPCI-A and comparison hospitals were similar. BPCI-A participation was associated with a decrease in payments for medical episodes (-$882 per episode; 95% CI -$1004 to -$760) and surgical episodes (-$587; 95% CI -$850 to -$324) compared with nonparticipant hospitals (absolute difference between change in medical and surgical episodes, -$295; 95% CI -$584 to -$5). BPCI-A participation was associated with a greater increase in healthy days at home and a greater decrease in both skilled nursing facility (SNF) admissions and SNF length of stay overall, but there were no significant differences between medical and surgical episodes in terms of the association of BPCI-A with changes in these outcomes. Conclusions and Relevance: In this cohort study analyzing the outcomes of the BPCI-A program for medical and surgical episodes, BPCI-A participation was associated with modestly decreased payments for both medical and surgical episodes compared with nonparticipants. Improvements in clinical outcomes associated with BPCI-A participation were also modest for both types of episodes; this study does not support a hypothesis that either medical or surgical episodes are better-suited for episode-based payments.
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