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.
N1 - Funding Information:
Joint Acknowledgment/Disclosure Statement: This work was supported by the
Funding Information:
Joint Acknowledgment/Disclosure Statement: This work was supported by the National Institute on Aging (Grant No. R01AG039434). Prior to completion of the study Andrew Ryan was supported by K01HS18546 from AHRQ, Terry Shih was supported by 5T32HL07612309 from the National Institutes of Health, and Lena Chen was supported by K08HS020671 from the Agency for Healthcare Research and Quality (AHRQ). Prior to the completion of the study, Lena Chen was also supported by R01HS024698 from AHRQ, 5P01AG019783 from the NIH/NIA, and 2059.11 from the?Blue Cross Blue Shield of Michigan Foundation Investigator Initiated Research Program. Justin Dimick, MD, MPH has equity interest in ArborMetrix, a company that profiles hospital quality and episode cost efficiency. The company played no role in this work. Lena Chen currently receives support from the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation for her work there. That support played no role in this work. No other disclosures, except as specified on attachment. Disclosures: None. Disclaimer: None.
Publisher Copyright:
© Health Research and Educational Trust
PY - 2018/4
Y1 - 2018/4
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 - Program evaluation
KW - health policy/politics/law/regulation
KW - surgery
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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 -