The Impact of Bundled Payments for Cardiopulmonary Disease on High-Risk Populations

心肺疾病捆绑支付对高危人群的影响

基本信息

批准号：
9917818
负责人：
Karen Ellen Joynt Maddox
金额：
$ 79.15万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9917818
关键词：
Address Adverse effects Back Cardiopulmonary Caring Case Mixes Chronic Chronic Obstructive Airway Disease Clinical Complex Data Elderly Healthcare Systems Heart failure Hospitals Incentives Intervention Learning Measures Medical Medicare Medicare/Medicaid Modeling Myocardial Infarction Operative Surgical Procedures Outcome Participant Patient-Focused Outcomes Patients Pattern Performance Physicians Pneumonia Policies Population Program Evaluation Provider Pulmonary Heart Disease Quality of Care Recommendation Replacement Arthroplasty Reporting Research Risk Savings Sepsis Services Surveys Testing Time Update Work acute care adverse outcome bundled payment care costs care episode care providers cost design experience financial incentive high risk high risk population hospital readmission improved innovation multiple chronic conditions payment programs safety net social social health determinants success

项目摘要

Abstract Our health care system is fragmented, which leads to suboptimal outcomes for high-risk populations with chronic conditions, such as cardiopulmonary disease, combined with complex medical or social needs. Bundled payments are an alternative payment model (APM) that incents efficiency by holding providers accountable for costs and quality across an entire episode of care. The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013; a new version of this program, BPCI-Advanced (BPCI-A), replaces BPCI in October 2018. Under both, participants that meet cost targets keep the savings, while those that fail to do so pay Medicare back the difference. BPCI- A has increased the financial incentives and added quality measures to further incentivize improvements. Bundled payments provide strong incentives for providers to better-coordinate services and redesign care, which could be very helpful for medically or socially high-risk older adults. These are populations for which clinical innovations are sorely needed, and knowing which ones are being tried and appear to be working could be very helpful in improving quality of care. On the other hand, bundled payments could induce providers to avoid those patients or skimp on care, which could result in poor outcomes. Our overarching hypothesis is that the financial incentives in BPCI had adverse consequences in high-risk cardiopulmonary patients, while the enhanced incentives and use of quality measures in BPCI-A will reduce some of those consequences. Quantifying the impact of BPCI-A on high-risk populations is critically important as Medicare and other payers increasingly shift towards these and other alternative payment models. Examining a variety of medical and surgical cardiopulmonary conditions that represent a range of acuity and complexity, our aims are to 1) Using claims data, determine how BPCI and BPCI-A impact cardiopulmonary spending, access, and outcomes for medically and socially high-risk populations; 2) Using a national survey, identify predictors of participation in BPCI-A, and key approaches to care redesign; and 3) Combining claims and survey data, determine patient, hospital, market, and strategic predictors of success under BPCI-A. Our proposed work will provide timely information to inform annual updates to BPCI-A, and identify clinical interventions that are strong candidates to improve cardiopulmonary care for all patients. Such work could help to protect and optimize outcomes among high-risk populations. Absent these findings and the resulting policy recommendations, BPCI-A could have unintended adverse consequences.

抽象的我们的医疗保健系统支离破碎，这导致高危人群的结果不佳慢性疾病，例如心肺疾病，以及复杂的医疗或社会需求。捆绑支付是一种替代支付模式 (APM)，通过控股提供商来提高效率对整个护理过程中的成本和质量负责。医疗保险和医疗补助中心创新 (CMMI) 于 2013 年推出了改善护理捆绑支付 (BPCI) 计划；一个新的该计划的版本 BPCI-Advanced (BPCI-A) 于 2018 年 10 月取代 BPCI。在这两个计划下，参与者达到成本目标的人保留节省的费用，而未能达到成本目标的人则向医疗保险退还差额。 BPCI- A 增加了财政激励措施并增加了质量措施，以进一步激励改进。捆绑支付为提供者更好地协调服务和重新设计护理提供了强有力的激励，这对于医疗或社会高危老年人可能非常有帮助。这些人群迫切需要临床创新，了解哪些创新正在尝试并且似乎有效可以对于提高护理质量非常有帮助。另一方面，捆绑支付可能会促使提供商避开这些患者或吝啬护理，这可能会导致不良结果。我们的总体假设是 BPCI 中的经济激励措施对高危心肺患者产生了不利后果，而 BPCI-A 中加强激励措施和使用质量措施将减少其中一些后果。量化 BPCI-A 对高危人群的影响对于 Medicare 和其他付款人至关重要越来越多地转向这些和其他替代支付模式。检查各种医疗和代表一系列严重性和复杂性的外科心肺疾病，我们的目标是 1) 使用索赔数据，确定 BPCI 和 BPCI-A 如何影响心肺支出、获取和结果医疗和社会高危人群； 2) 通过全国调查，确定参与的预测因素 BPCI-A 和护理重新设计的关键方法； 3) 结合索赔和调查数据，确定患者， BPCI-A 下成功的医院、市场和战略预测因素。我们提出的工作将提供及时的信息，以告知 BPCI-A 的年度更新，并确定临床干预措施是改善所有患者心肺护理的有力候选者。这样的工作可以帮助保护和优化高风险人群的结果。缺乏这些发现和由此产生的政策根据建议，BPCI-A 可能会产生意想不到的不良后果。