Association of Skilled Nursing Facility Participation in Voluntary Bundled Payments With Postacute Care Outcomes for Joint Replacement. Issue 2 (12th February 2023)

• Record Type: Journal Article
• Authors: Ying, Meiling; Thirukumaran, Caroline P.; Temkin-Greener, Helena; Joynt Maddox, Karen E.; Holloway, Robert G.; Li, Yue
• Is Part Of: Medical care. Volume 61:Issue 2(2023)
• Page Start: 109
• Page End: 116
• Publication Date: 2023-02-12
• Subjects: Medicare bundled payments -- skilled nursing facility -- readmissions -- successful community discharge -- disparities; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001799
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Importance: The Medicare Bundled Payments for Care Improvement (BPCI) model 3 of 2013 holds participating skilled nursing facilities (SNFs) responsible for all episode costs. There is limited evidence regarding SNF-specific outcomes associated with BPCI. Objective: To examine the association between SNF BPCI participation and patient outcomes and across-facility differences in these outcomes among Medicare beneficiaries undergoing lower extremity joint replacement (LEJR). Design, Setting, and Participants: Observational difference-in-differences (DID) study of 2013–2017 for 330 unique persistent-participating SNFs, 146 unique dropout SNFs, and 14, 028 unique eligible nonparticipating SNFs. Main Outcome Measures: Rehospitalization within 30 and 90 days after SNF admission, and rate of successful discharge from the SNF to the community. Results: Total 636, 355 SNF admissions after LEJR procedures were identified for 582, 766 Medicare patients [mean (SD) age, 76.81 (9.26) y; 424, 076 (72.77%) women]. The DID analysis showed that for persistent-enrollment SNFs, no BPCI-related changes were found in readmission and successful community discharge rates overall, but were found for their subgroups. Specifically, under BPCI, the 30-day readmission rate decreased by 2.19 percentage-points for White-serving SNFs in the persistent-participating group relative to those in the nonparticipating group, and by 1.75 percentage-points for non-Medicaid–dependent SNFs in the persistent-participating group relative to those in the nonparticipating group; and the rate of successful community discharge increased by 4.44 percentage-points for White-serving SNFs in the persistent-participating group relative to those in the nonparticipating group, whereas such relationship was not detected among non-White–serving SNFs, leading to increased between-facility differences (differential DID=−7.62). BPCI was not associated with readmission or successful community discharge rates for dropout SNFs, overall, or in subgroup analyses. Conclusions: Among Medicare patients receiving LEJR, BPCI was associated with improved outcomes for White-serving/non-Medicaid–dependent SNFs but not for other SNFs, which did not help reduce or could even worsen the between-facility differences.