Skilled Nursing Facility Participation in Medicare's Bundled Payments for Care Improvement Initiative: A Retrospective Study.
Lianna Weissblum, Peter Huckfeldt, José Escarce and 2 others
PMID 30291827WHAT IT FOUND
Before Medicare bundled payments began, skilled nursing facilities that triggered episodes had shorter stays and fewer 90-day readmissions than non-participants.
Facilities that took financial risk had lower figures too, but only episode-triggering facilities showed differences that stood out.
Key findings
01Awardee SNF patients had higher late loss ADL scores than non-participant patients (9.1 versus 8.3). The paper says this means greater impairment.
02Initial SNF length of stay was lower for Episode Initiator SNFs (34.9 days) than non-participants (36.8 days), and the study reported this difference as statistically significant.
03Hospital readmission within 90 days was 0.8% lower for Episode Initiator episodes (24.6% versus 25.4%), and the study reported this difference as statistically significant.
STILL TO COME
How it was doneWhat they found
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What it does not show
Participation was voluntary, so facilities that became Awardees or Episode Initiators may have differed from non-participants in ways the study could not measure. The analysis looked before BPCI began, so it does not show how outcomes changed after participation. Because participants were selected, the findings may not generalise to all skilled nursing facilities. The paper reports differences in length of stay and readmission, but it does not test whether bundled payments caused them. The paper does not report therapy services or therapy outcomes.
Declared interests
The supplied text does not include an author conflict of interest statement. Publication types indicate NIH extramural research support.
The easy way to misread this
Do not read shorter stays and lower readmission as evidence that bundled payments improved care. These differences were measured before participation, participation was voluntary, and the study did not compare outcomes after BPCI.