Hospital participation in five common medical bundles under the Bundled Payments for Care Improvement (BPCI) initiative, when compared to nonparticipation, may not be associated with changes in Medicare payments, clinical complexity, length of stay, emergency department use, hospital readmission or mortality, according to an article published July 18 in the New England Journal of Medicine.

BPCI, a voluntary episode-based payment program, was launched by the Center for Medicare and Medicaid Innovation (CMMI) in 2013. Karen E. Joynt Maddox, MD, MPH, et al., used Medicare claims from 2013 through 2015 to identify admissions for the five most commonly selected medical conditions within BPCI – congestive heart failure, pneumonia, chronic obstructive pulmonary disease, sepsis and acute myocardial infarction – and assessed changes in standardized Medicare payments per episode of care for these conditions at BPCI hospitals and matched control hospitals.

The authors found no significant changes in total or component Medicare episode payments and found no significant overall differences between BPCI hospitals and control hospitals in the change from baseline to the intervention period for length of stay, emergency department visits or readmissions within 30 or 90 days after discharge, or mortality within 30 or 90 days after admission.

Regarding changes in Medicare payments, at baseline, the average Medicare payment per episode of care observed for BPCI hospitals was $24,280, decreasing to $23,993 during the intervention period (difference, −$286; P = 0.41) Control hospitals had an average payment for all episodes of $23,901, which decreased to $23,503 during the intervention period (difference, −$398; P = 0.08; difference in differences, $112; P = 0.79).

The authors explain that a possibility for the failure of BPCI hospitals to reduce allowed payments is a lack of ability to influence care provided by skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals or home health agencies, as hospitals may have little say in what happens to patients once they enter a post–acute care setting.

Moving forward, the authors called for further innovation within bundled-payment models. “Bundling of services to encourage more efficient care has great face validity and enjoys bipartisan support,” write Maddox et al. “For such bundling to work for medical conditions, however, more time, new care strategies and partnerships, or additional incentives may be required.”

Keywords: Medicaid, Length of Stay, Skilled Nursing Facilities, Subacute Care, Patient Readmission, Home Care Agencies, Episode of Care, Inpatients, Long-Term Care, Medicare, Patient Discharge, Health Expenditures, Hospitals, Emergency Service, Hospital, Pneumonia, Sepsis, Pulmonary Disease, Chronic Obstructive, Heart Failure, Reproducibility of Results, Myocardial Infarction

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