Patient-reported Outcomes Among Vulnerable Populations in the Medicare Bundled Payments for Care Improvement Initiative

McClellan, Sean R.; Trombley, Matthew J.; Maughan, Brandon C.; Kahvecioglu, Daver C.; Marshall, Jaclyn; Marrufo, Grecia; Kummet, Colleen; Hassol, Andrea

doi:10.1097/mlr.0000000000001644

Cited by 4 publications

(7 citation statements)

References 30 publications

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“…The survey instrument was based on the instrument used in the evaluation of the BPCI Initiative. [10][11][12][13] New measures were adapted from validated survey instruments (as described under the measures section below) or were developed by the research team. All questions underwent cognitive testing with a convenience sample of Medicare beneficiaries with recent joint replacement surgeries.…”

Section: Methodsmentioning

confidence: 99%

“…Constructing selfreported change in functional status from recalled and current function is consistent with the approach used in the evaluation of the BPCI Initiative. [10][11][12][13] The survey also included eight questions related to the respondent's perception about care experience: discharged from the hospital at the right time; received the right amount of care in the 2 weeks after surgery; had all the medical equipment needed at home; satisfaction with overall recovery; satisfaction with the extent to which health care providers listened to your treatment preferences; satisfaction with discharge destination; satisfaction with care coordination; and satisfaction with treatment instructions received.…”

Section: Methodsmentioning

confidence: 99%

“…The survey was designed to take 25 min to complete. The survey instrument was based on the instrument used in the evaluation of the BPCI Initiative 10–13 . New measures were adapted from validated survey instruments (as described under the measures section below) or were developed by the research team.…”

Section: Methodsmentioning

confidence: 99%

“…Prior patient survey results from BPCI Model 2 indicated that BPCI was associated with a slightly higher probability of negative self-reported care experiences but was not associated with self-reported changes in functional status from before surgery through the end of the episode. [10][11][12] However, hospital participation in BPCI was voluntary, and there has not yet been a similar investigation of patient-reported outcomes among the mandatory CJR participating hospitals. Volunteering for T A B L E 1 High-payment MSAs randomly assigned to mandatory participation in CJR and high-payment MSAs randomly assigned to the control group…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, CMS regularly includes large‐scale patient surveys in the evaluation of episode‐based payment initiatives (e.g., BPCI Initiative, BPCI Advanced Model, Oncology Care Model) to evaluate patient‐reported measures of care quality. Prior patient survey results from BPCI Model 2 indicated that BPCI was associated with a slightly higher probability of negative self‐reported care experiences but was not associated with self‐reported changes in functional status from before surgery through the end of the episode 10–12 . However, hospital participation in BPCI was voluntary, and there has not yet been a similar investigation of patient‐reported outcomes among the mandatory CJR participating hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Comprehensive Care for Joint Replacement model on patient‐reported outcomes

Trombley

Joneydi

Buatti

et al. 2022

Health Services Research

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Objective To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode‐based payment program for knee and hip replacement surgery, affected patient‐reported measures of quality. Data Sources Surveys of Medicare fee‐for‐service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files. Study Design In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower‐extremity joint replacements surgery. The control group included 47 high‐payment MSAs randomly assigned as controls. We estimated risk‐adjusted differences in self‐reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group. Data Collection We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents. Principal Findings CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post‐acute care stay). On a 100‐point scale, differences ranged from −2.6 points (p < 0.01) for help needed bathing to −1.7 points (p < 0.05) for help needed using the toilet. However, differences in eight measures of self‐reported functional status approximately 90–120 days after hospital discharge were not statistically significant, ranging from −1.1% (p = 0.087) to 0.7% (p = 0.437). Conclusions CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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