Skilled Nursing Facility Participation in Medicare’s Bundled Payments for Care Improvement Initiative: A Retrospective Study

Publication date: Available online 4 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Lianna Weissblum, Peter Huckfeldt, José Escarce, Pinar Karaca-Mandic, Neeraj Sood

Abstract

Objective

To investigate differences in facility characteristics, patient characteristics, and outcomes between skilled nursing facilities (SNFs) that participated in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) initiative and non-participants, prior to BPCI.

Design

Retrospective, cross-sectional comparison of BPCI participants and non-participants.

Setting

SNFs

Participants

All Medicare-certified SNFs (n = 15,172) and their 2011-2012 episodes of care for chronic obstructive pulmonary disease, congestive heart failure, femur and hip/pelvis fracture, hip and femur procedures, lower extremity joint replacement, and pneumonia (n = 873,739).

Interventions

Participation in a bundled payment program that included taking financial responsibility for care within a 90 day episode.

Main Outcome Measures

This study investigates the characteristics of bundled payment participants and their patient characteristics and outcomes relative to non-participants prior to BPCI, to understand the implications of a broader implementation of bundled payments.

Results

SNFs participating in BPCI were more likely to be in urban areas (80.8-98.4% versus 69.5%) and belong to a chain or system (73.8-85.5% versus 55%), and were less likely to be located in the south (13.1-20.2% versus 35.4%). Quality performance was similar or higher in most cases for SNFs participating in BPCI relative to non-participants. In addition, BPCI participants admitted higher socioeconomic status patients with similar clinical characteristics. Initial SNF length of stay was shorter and hospital readmission rates were lower for BPCI patients compared to non-participant patients.

Conclusions

We found that SNFs participating in the second financial risk-bearing phase of BPCI represented a diversity of SNF types, regions, and levels of quality and the results may provide insight into a broader adoption of bundled payment for post-acute providers.

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