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Effectiveness of a Bundled Payments for Care Improvement Program for Chronic Obstructive Pulmonary Disease

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Abstract

Background

The Medicare Bundled Payments for Care Improvement (BPCI) program reimburses 90-day care episodes post-hospitalization. COPD is a leading cause of early readmissions making it a target for value-based payment reform.

Objective

Evaluate the financial impact of a COPD BPCI program.

Design, Participants, Interventions

A single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention.

Main Measures

Mean episode costs and readmissions.

Key Results

Between October 2015 and September 2018, 132 received and 161 did not receive the program, respectively. Mean episode costs were below target for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 (95% CI: − $811 to $5795) in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG); there were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode was observed in 90-day readmission rates for intervention relative to control. Readmissions and hospital discharges to skilled nursing facilities were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).

Conclusions

Our COPD BPCI program had a non-significant cost-saving effect, although sample size limited study power. The differential impact of the intervention by DRG suggests that targeting interventions to more clinically complex patients could increase the financial impact of the program. Further evaluations are needed to determine if our BPCI program decreased care variation and improved quality of care.

Primary Source of Funding

This research was supported by NIH NIA grant #5T35AG029795-12.

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Data Availability

Since the data used in this manuscript are highly granular and contains potentially sensitive patient information, public sharing of the data would breach the University of Chicago’s IRB protocol requirements. Interested researchers may contact Valerie Press via email at vpress@medicine.bsd.uchicago.edu for data requests.

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Acknowledgements

We thank the COPD Program advanced practice nurses. We also thank the Center for Transformative Care for their support of our BPCI program and for data assistance. Finally, we thank Mary Akel for her administrative assistance.

Funding

AW was supported in part by the NIH NIA grant #5T35AG029795-12. The funder played no role in the collection, design, or reporting of data for this work. These data were collected independently from any funding source.

Author information

Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, USA

    Amelia Waltman MD

  2. Department of Public Health Sciences, University of Chicago, Chicago, USA

    R Tamara Konetzka PhD

  3. Center for Transformative Care, University of Chicago Medicine, Chicago, USA

    Stephanie Chia BA, Assad Ghani MBA & Rajlakshmi Krishnamurthy MD

  4. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, USA

    Wen Wan PhD & Valerie G. Press MD, MPH

  5. Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, Chicago, USA

    Steven R. White MD

  6. Section of Academic Pediatrics, Department of Pediatrics, University of Chicago, 5841 S Maryland, MC 2007, Chicago, USA

    Valerie G. Press MD, MPH

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Contributions

AW and VGP conceptualized this study, assisted with data collection and analyses, and interpreted the data, as well as drafted and revised the manuscript. TK, SC, RK, and SRW helped design of the study, interpreted the data, and critically revised the manuscript. WW assisted in data cleaning and data analyses, assisted with data interpretation, and critically revised the manuscript. AG contributed to data interpretation as well as critical revision of the manuscript. All authors reviewed and approved the final manuscript. They agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Valerie G. Press MD, MPH.

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Prior Presentations.

We previously presented these findings at our institution, the University of Chicago, as a poster at the 2019 Janet Rowley Department of Medicine Research Day, the Sixth Annual Research Symposium and Poster Session by the Center for Chronic Disease Research and Policy, and the 2018 UCM Quality Fair. We have also presented the work as a poster for the 2020 American Thoracic Society Annual Meeting and as an oral presentation at the 2020 Midwest Society of General Internal Medicine Annual Conference.

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Waltman, A., Konetzka, R.T., Chia, S. et al. Effectiveness of a Bundled Payments for Care Improvement Program for Chronic Obstructive Pulmonary Disease. J GEN INTERN MED 38, 2662–2670 (2023). https://doi.org/10.1007/s11606-023-08249-6

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