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 language | English (US) |
|---|---|
| Pages (from-to) | 632-648 |
| Number of pages | 17 |
| Journal | Health Services Research |
| Volume | 53 |
| Issue number | 2 |
| DOIs | |
| State | Published - Apr 1 2018 |
| Externally published | Yes |
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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 journal › Article
}
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 -