Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care

Lena M. Chen, Andrew M. Ryan, Terry Shih, Jyothi R. Thumma, Justin B. Dimick

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program—an early, small, voluntary episode-based payment program—was associated with a change in expenditures or quality of care. Data Sources/Study Setting: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. Study Design: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls. Principal Findings: Participation in the ACE Demonstration was not significantly associated with 30-day Medicare payments (for orthopedic surgery: −$358 with 95 percent CI: −$894, +$178; for cardiac surgery: +$514 with 95 percent CI: −$1,517, +$2,545), or 30-day mortality (for orthopedic surgery: −0.10 with 95 percent CI: −0.50, 0.31; for cardiac surgery: −0.27 with 95 percent CI: −1.25, 0.72). Program participation was associated with a decrease in total 30-day post-acute care payments (for cardiac surgery: −$718; 95 percent CI: −$1,431, −$6; and for orthopedic surgery: −$591; 95 percent CI: $-$1,161, −$22). Conclusions: Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.

Original languageEnglish (US)
Pages (from-to)632-648
Number of pages17
JournalHealth Services Research
Volume53
Issue number2
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Fingerprint

Episode of Care
Quality of Health Care
Medicare
Thoracic Surgery
Orthopedics
Costs and Cost Analysis
Subacute Care
Mortality
Information Storage and Retrieval
Health Expenditures

Keywords

  • health policy/politics/law/regulation
  • Program evaluation
  • surgery

ASJC Scopus subject areas

  • Health Policy

Cite this

Medicare's Acute Care Episode Demonstration : Effects of Bundled Payments on Costs and Quality of Surgical Care. / Chen, Lena M.; Ryan, Andrew M.; Shih, Terry; Thumma, Jyothi R.; Dimick, Justin B.

In: Health Services Research, Vol. 53, No. 2, 01.04.2018, p. 632-648.

Research output: Contribution to journalArticle

Chen, Lena M. ; Ryan, Andrew M. ; Shih, Terry ; Thumma, Jyothi R. ; Dimick, Justin B. / Medicare's Acute Care Episode Demonstration : Effects of Bundled Payments on Costs and Quality of Surgical Care. In: Health Services Research. 2018 ; Vol. 53, No. 2. pp. 632-648.
@article{5b945234db4a4354a328ffaf9168b9ec,
title = "Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care",
abstract = "Objective: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program—an early, small, voluntary episode-based payment program—was associated with a change in expenditures or quality of care. Data Sources/Study Setting: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. Study Design: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls. Principal Findings: Participation in the ACE Demonstration was not significantly associated with 30-day Medicare payments (for orthopedic surgery: −$358 with 95 percent CI: −$894, +$178; for cardiac surgery: +$514 with 95 percent CI: −$1,517, +$2,545), or 30-day mortality (for orthopedic surgery: −0.10 with 95 percent CI: −0.50, 0.31; for cardiac surgery: −0.27 with 95 percent CI: −1.25, 0.72). Program participation was associated with a decrease in total 30-day post-acute care payments (for cardiac surgery: −$718; 95 percent CI: −$1,431, −$6; and for orthopedic surgery: −$591; 95 percent CI: $-$1,161, −$22). Conclusions: Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.",
keywords = "health policy/politics/law/regulation, Program evaluation, surgery",
author = "Chen, {Lena M.} and Ryan, {Andrew M.} and Terry Shih and Thumma, {Jyothi R.} and Dimick, {Justin B.}",
year = "2018",
month = "4",
day = "1",
doi = "10.1111/1475-6773.12681",
language = "English (US)",
volume = "53",
pages = "632--648",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Medicare's Acute Care Episode Demonstration

T2 - Effects of Bundled Payments on Costs and Quality of Surgical Care

AU - Chen, Lena M.

AU - Ryan, Andrew M.

AU - Shih, Terry

AU - Thumma, Jyothi R.

AU - Dimick, Justin B.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objective: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program—an early, small, voluntary episode-based payment program—was associated with a change in expenditures or quality of care. Data Sources/Study Setting: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. Study Design: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls. Principal Findings: Participation in the ACE Demonstration was not significantly associated with 30-day Medicare payments (for orthopedic surgery: −$358 with 95 percent CI: −$894, +$178; for cardiac surgery: +$514 with 95 percent CI: −$1,517, +$2,545), or 30-day mortality (for orthopedic surgery: −0.10 with 95 percent CI: −0.50, 0.31; for cardiac surgery: −0.27 with 95 percent CI: −1.25, 0.72). Program participation was associated with a decrease in total 30-day post-acute care payments (for cardiac surgery: −$718; 95 percent CI: −$1,431, −$6; and for orthopedic surgery: −$591; 95 percent CI: $-$1,161, −$22). Conclusions: Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.

AB - Objective: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program—an early, small, voluntary episode-based payment program—was associated with a change in expenditures or quality of care. Data Sources/Study Setting: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. Study Design: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls. Principal Findings: Participation in the ACE Demonstration was not significantly associated with 30-day Medicare payments (for orthopedic surgery: −$358 with 95 percent CI: −$894, +$178; for cardiac surgery: +$514 with 95 percent CI: −$1,517, +$2,545), or 30-day mortality (for orthopedic surgery: −0.10 with 95 percent CI: −0.50, 0.31; for cardiac surgery: −0.27 with 95 percent CI: −1.25, 0.72). Program participation was associated with a decrease in total 30-day post-acute care payments (for cardiac surgery: −$718; 95 percent CI: −$1,431, −$6; and for orthopedic surgery: −$591; 95 percent CI: $-$1,161, −$22). Conclusions: Participation in Medicare's ACE Demonstration Program was not associated with a change in 30-day episode-based Medicare payments or 30-day mortality for cardiac or orthopedic surgery, but it was associated with lower total 30-day post-acute care payments.

KW - health policy/politics/law/regulation

KW - Program evaluation

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85017104743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017104743&partnerID=8YFLogxK

U2 - 10.1111/1475-6773.12681

DO - 10.1111/1475-6773.12681

M3 - Article

C2 - 28369885

AN - SCOPUS:85017104743

VL - 53

SP - 632

EP - 648

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 2

ER -