Medicare’s bundled payments for care improvement initiative maintained quality of care for vulnerable patients

Brandon Maughan, Daver C. Kahvecioglu, Grecia Marrufo, Gina M. Gerding, Syvart Dennen, Jaclyn K. Marshall, Daniel M. Cooper, Colleen M. Kummet, Laura A. Dummit

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The Bundled Payments for Care Improvement (BPCI) initiative established four models to test whether linking payments for an episode of care could reduce Medicare payments while maintaining or improving quality. Evaluations concluded that model 2, the largest, generally lowered payments without reducing quality for the average beneficiary, but these global results could mask adverse findings among vulnerable subpopulations. We analyzed changes in emergency department visits, unplanned hospital readmissions, and all-cause mortality within ninety days of hospital discharge among beneficiaries with one or more of three vulnerable characteristics—dementia, dual eligibility for Medicare and Medicaid, and recent institutional care—in 105,458 beneficiary episodes in the period October 2013–December 2016. The results for twelve types of medical and surgical BPCI episodes were evaluated relative to results in matched comparison groups. Our findings suggest that BPCI model 2 did not adversely affect care quality for beneficiaries with vulnerabilities. While this conclusion does not discourage the further development of bundled payment models, policy makers should support ongoing research to ensure that vulnerable populations are not adversely affected by these approaches.

Original languageEnglish (US)
Pages (from-to)561-568
Number of pages8
JournalHealth Affairs
Volume38
Issue number4
DOIs
StatePublished - Apr 1 2019

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Episode of Care
Quality of Health Care
Dual MEDICAID MEDICARE Eligibility
Medicare
Patient Readmission
Vulnerable Populations
Masks
Administrative Personnel
Hospital Emergency Service
Research Design
Mortality
Research

ASJC Scopus subject areas

  • Health Policy

Cite this

Maughan, B., Kahvecioglu, D. C., Marrufo, G., Gerding, G. M., Dennen, S., Marshall, J. K., ... Dummit, L. A. (2019). Medicare’s bundled payments for care improvement initiative maintained quality of care for vulnerable patients. Health Affairs, 38(4), 561-568. https://doi.org/10.1377/hlthaff.2018.05146

Medicare’s bundled payments for care improvement initiative maintained quality of care for vulnerable patients. / Maughan, Brandon; Kahvecioglu, Daver C.; Marrufo, Grecia; Gerding, Gina M.; Dennen, Syvart; Marshall, Jaclyn K.; Cooper, Daniel M.; Kummet, Colleen M.; Dummit, Laura A.

In: Health Affairs, Vol. 38, No. 4, 01.04.2019, p. 561-568.

Research output: Contribution to journalArticle

Maughan, B, Kahvecioglu, DC, Marrufo, G, Gerding, GM, Dennen, S, Marshall, JK, Cooper, DM, Kummet, CM & Dummit, LA 2019, 'Medicare’s bundled payments for care improvement initiative maintained quality of care for vulnerable patients', Health Affairs, vol. 38, no. 4, pp. 561-568. https://doi.org/10.1377/hlthaff.2018.05146
Maughan, Brandon ; Kahvecioglu, Daver C. ; Marrufo, Grecia ; Gerding, Gina M. ; Dennen, Syvart ; Marshall, Jaclyn K. ; Cooper, Daniel M. ; Kummet, Colleen M. ; Dummit, Laura A. / Medicare’s bundled payments for care improvement initiative maintained quality of care for vulnerable patients. In: Health Affairs. 2019 ; Vol. 38, No. 4. pp. 561-568.
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