The Centers for Medicare and Medicaid Services (CMS)’s released its second annual evaluation of the Bundled Payments for Care Improvement (BPCI) initiative.

The report, prepared by The Lewin Group, includes quantitative results for participants in Models 2, 3 and 4 for the first year of the program (October 2013 through September 2014) and qualitative results through June 2015. 

The models vary by bundle definitions (e.g., Model 3 does not include the triggering hospital stay) and payment approaches (e.g., retrospective payment reconciliations vs. prospective payments). The results included in the report are for nearly 60,000 episodes of care for 15 clinical episode groups initiated by 130 hospitals, 63 skilled nursing facilities, 28 home health agencies and four physician group practices. 

CMS noted that small sample sizes and the limited duration of the BPCI thus far limit the ability to estimate the impact of the initiative. Overall, 11 of the 15 clinical episode groups showed potential savings to Medicare, including orthopedic and cardiovascular surgery. 

A study published online Sept. 19 by JAMA compared the Medicare bundled payments and outcomes for lower extremity joint replacement episodes initiated during a one-year period before the BPCI was launched versus similar episodes initiated during the first 21 months of the BPCI for participating and nonparticipating hospitals. 

The analysis showed that the average Medicare payment for the BPCI-participating hospitals decreased by $3,286 during the program’s first 21 months, whereas the average Medicare payment for nonparticipating hospitals decreased by $2,119. The difference was attributed mostly to reduced use of institutional post-acute care. There was no significant change in quality outcomes.

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