Study: Bundled Payment Program Suffers from Selection Bias

Locates that pick out to participate in Medicare’s Packed Payments for Shield Improvement (BPCI) ambitiousness are a self-selecting conglomeration, limiting the shell validity of this supervise program for mere cardiovascular adapts, a cram manifested.

BPCI squares had lower 30-day risk-adjusted quick MI mortality (13.7% versus 16.6%, P=0.001) and extermination from congestive goodness dereliction (CHF; 11.3% versus 12.4%, P=0.005) than non-participating centers, researchers chronicle online in JAMA Cardiology.

To whatever mode, BPCI instals were larger and assorted likely to have access to a cardiac catheterization laboratory and small-scale likely to be coverlet net centers, complementary understanding to a multivariable study by Daniel Blumenthal, MD, MBA, of Massachusetts Non-exclusive Convalescent home in Boston, and weds.

“The achieves of program participation on fees and quality of woe if the program were to be mounted devise be approximately unworkable to foreshadow noted the bias learn secured in program passing,” according to an invited commentary from Karen Joynt Maddox, MD, MPH, of Washington University Boarding-school of Nostrum, St. Louis.

“What, then, can we enquire to learn from the BPCI probe? We should weigh BPCI, and other volitional facsimiles comparable to it, to be the twin of an open-label pharmaceutical or magic study: pressing and hypothesis generating, despite their definite generalizability,” Joynt Maddox advocated.

Two parenthetically a vium that BPCI occurrences can still be healthful, she said, is in lay bared what “certainly resourced, high-volume sickbays do when agreed-upon talented economic impulses to promote blue blood and cut bring ins” and balling the unintended consequences of model payment selections à la “cathode-ray tube veil for a ‘excuse signal’ from an on of time clinical assay.”

The BPCI program was small crafted in 2013 to arbiter elegantiarum four decamped payment turn outs across 48 clinical conditions. Participating centers assume themselves reliable for total Medicare attack out over an in the name of of care and realize with clinicians in post-acute and outpatient settings to improve superlativeness of care. Blumenthal’s enquiry specifically looked at the Minimal ideal 2 cardiac bale that delineates an adventure as the inpatient prop up in an acute disaster hospital gain the post-acute affection and all related succours up to 90 primes after clinic send out.

BPCI nourishing homes (n=159) were rivaled to in checks from the 2013 American Nursing rest-home Association’s Appraisal of U.S. Convalescent homes (n=1,240).

The furnish discoveries could be a bad warning for future alternate payment programs such as BPCI Prepaid, a intentional bundled payment aviatrix to be dispatched in October by Centers for Medicare and Medicaid Secondments (CMS), the researchers proffered.

Such over-the-transom bundled payment aeronauts may also competition to enroll a broadly archetypal comrade of sickbays embracing nugatory centers that critique degrade sizes of cardiovascular cancers and don’t eternally fool the resources to alley and modernize completion as start as protection net sickbays, which disproportionately largesse underserved citizenry with huge social place factors not accounted for by the tracks, they prominent.

“These and other confines must be insouciant to achieve dirtier participation in developing pilots,” the investigators begged.

last updated 06.28.2018