Cooperating with private consulting companies can encourage hospitals to participate in more events in the federal bundled payment program, according to New research.
Advanced Model of Voluntary Bundled Payment of Care Improvement Plan, or BPCI Advanced, To compare expenditures for specific clinical episodes (such as congestive heart failure or sepsis) with benchmarks set by the Medicare and Medicaid Services Center. The hospital bears the financial risk of the plan-if the expenditure is lower than the benchmark for clinical events, the hospital will be rewarded; but if the expenditure is more, the hospital will pay a fine.
In addition, eligible hospitals can independently participate in the model or cooperate with the convener, including private consulting companies that share financial risks.
“We are interested in understanding how private consulting firms influence hospital decisions about participation [the] Medical insurance bundled payment plan,” the research author and national clinician scholar Dr. Nicholas Berlin of the University of Michigan Medical Policy and Innovation Institute said in an email. “More specifically, we studied whether the hospitals that cooperate with these companies Be more sensitive to the financial incentives of the plan. “
For this study published in Health Affairs, the researchers examined a sample of Medicare fee-for-service claims of beneficiaries discharged from the hospital between January 1, 2013 and September 30, 2016. The total sample included 28 BPCI Advanced hospitalized clinical episodes in 2,988 hospitals. The hospital participation data and hospital event participation data of BPCI Advanced are publicly reported by CMS.
Approximately 63.6% of clinical events in participating hospitals included private consulting companies.
Research shows that non-teaching and for-profit hospitals participating in BPCI Advanced are more likely than other hospitals to cooperate with private consulting companies.
In addition, compared with hospitals that did not cooperate, hospitals that cooperated with consulting companies participated in the model more frequently.
“We are surprised that hospitals that work with these companies are more likely to participate in more incidents,” Berlin said. “These hospital-company partners must think they can be successful in certain situations, while other hospitals don’t.”
Hospitals that cooperate with consulting companies are also more likely to choose episodes with a higher CMS price benchmark, and episodes that have more opportunities to reduce post-acute care and readmission expenses.
However, while collaboration with consulting companies may increase overall participation, these companies are “very savvy and highly sensitive to financial incentives, and in the long run, it may be more difficult for CMS to save money under this model,” Berlin said.
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