Bundled Payments for Care Improvement (BPCI) Efficacy across Three Common Operations.

OBJECTIVE: To evaluate associations between hospital participation in Bundled Payments for Care Improvement (BPCI) and thirty-day total episode and post-acute care spending for lower extremity joint replacement (LEJR), coronary artery bypass graft (CABG), and colectomy.

SUMMARY BACKGROUND DATA: BPCI has been shown to reduce spending for LEJR episodes only, largely from reductions in post-acute care. However, BPCI efficacy in other common elective procedures, including CABG and colectomy, remains unclear. It is also unknown whether post-acute care spending reductions drive total spending reductions outside of LEJR.

METHODS: Retrospective cohort study using 100% Medicare claims data to identify BPCI (312 total) and non-BPCI (1,977 total) acute care hospitals from January 1, 2010 to November 30, 2016 with Medicare-enrolled patient discharges for at least one BPCI episode: LEJR (454,369 episodes), CABG (107,307 episodes), or colectomy (73,717 episodes). Along with difference-in-differences analysis, we constructed generalized synthetic controls in the presence of non-parallel trends to estimate associations between BPCI participation and thirty-day total and post-acute care spending.

RESULTS: Difference-in-differences estimates indicated reduced spending for LEJR (-$541.6 (95% CI: -718.0 to -365.3)) and colectomy (-$582.1 (95% CI: -927.3 to -236.8)) but not CABG (-$268.9 (95% CI: -831.5 to 293.7)). Generalized synthetic control estimates indicated reduced spending for LEJR (-$795.3 (95% CI: -1022.1 to -582.2)) but not colectomy (-$251.3 (95% CI: -997.9 to 335.2)) or CABG (-$257.8 (95% CI: -1024.6 to 414.8)). Post-acute care comprised 42.6% of LEJR spending reductions and 53.0% of colectomy spending reductions.

CONCLUSIONS: BPCI participation was associated with significant spending reductions for LEJR and colectomy but not CABG. We conclude that BPCI has episode-dependent efficacy, largely determined by post-acute care.