Patient-reported Outcomes Among Vulnerable Populations in the Medicare Bundled Payments for Care Improvement Initiative
Bibliographic Data
BACKGROUND: The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative tested whether episode-based payment models could reduce Medicare payments without harming quality. Among patients with vulnerabilities, BPCI appeared to effectively reduce payments while maintaining the quality of care. However, these findings could overlook potential adverse patient-reported outcomes in this population. RESEARCH DESIGN: We surveyed beneficiaries with 4 characteristics (Medicare-Medicaid dual eligibility; dementia; recent institutional care; or racial/ethnic minority) treated at BPCI-participating or comparison hospitals for congestive heart failure, sepsis, pneumonia, or major joint replacement of the lower extremity. We estimated risk-adjusted differences in patient-reported outcomes between BPCI and comparison respondents, stratified by clinical episode and vulnerable characteristic. MEASURES: Patient care experiences during episodes of care and patient-reported functional outcomes assessed roughly 90 days after hospitalization. RESULTS: We observed no differences in self-reported functional improvement between BPCI and comparison respondents with vulnerable characteristics. Patient-reported care experience was similar between BPCI and comparison respondents in 11 of 15 subgroups of clinical episode and vulnerability. BPCI respondents with congestive heart failure, sepsis, and pneumonia were less likely to indicate positive care experiences than comparison respondents for at least 1 subgroup with vulnerabilities. CONCLUSIONS: As implemented by hospitals, BPCI Model 2 was not associated with adverse effects on patient-reported functional status among beneficiaries who may be vulnerable to reductions in care. Hospitals participating in heart failure, sepsis or pneumonia bundled payment episodes should focus on patient care experience while implementing changes in care delivery
Environmental health · Family medicine · Health care · Medicaid · Pneumonia · Population · Chronic Disease Management Strategies · Healthcare Policy and Management · Internal Medicine · Medicine · Primary Care and Health Outcomes
Validating the SF-36 health survey questionnaire
Race/Ethnicity, Language, and Patients' Assessments of Care in Medicaid Managed Care
Methods for Constructing and Assessing Propensity Scores
Multivariate Matching Methods That Are Monotonic Imbalance Bounding
Thirty‐Day Readmission Rates Among Dual‐Eligible Beneficiaries
Disparities in Health Care by Race, Ethnicity, and Language Among the Insured
Assessing the Quality of Preparation for Posthospital Care from the Patient??s Perspective
Measuring patient-centered communication in Patient-Physician consultations
| Highly cited | No |
|---|