CMS teams up with Altarum Institute: BPCI doesn’t increase procedure volume

Centers for Medicare and Medicaid Services (CMS) has partnered with the Altarum Institute to debunk the argument by Elliot Fisher, MD, director of Lebanon, N.H.-based Dartmouth Institute for Health Policy and Clinical Practice, that Bundled Payments for Care Initiative of CMS increases procedure volume.

The study of CMS-Altarum is a straight response to an editorial released last September in JAMA. The editorial disputed the findings of another study in the similar issue of JAMA that discovered Medicare payments for lower extremity joint replacement episodes reduced more in BPCI hospitals than non-BPCI hospitals during the first 21 months of the program. The dissenting editorial stated that there was a major increase in procedure volume between the baseline and performance years for hospitals engaging in BPCI compared to non-BPCI hospitals, and that this might have increased overall total spend, instead of reducing it. In accordance to the suggestion of editorial, BPCI program could be incentivizing providers to perform more processes and procedures.
CMS and Altarum Institute examined Medicare Part A claims and counted major lower joint replacement procedures at all hospitals to investigate this claim between the time period of 2011 and 2015. Any hospitals with eleven or fewer procedures in any year between the time period of 2011 or 2015 were thrown out. A difference-in-differences model was then used by the researchers to compare the average change in joint replacement procedure volume between BPCI hospitals and non-BPCI hospitals. They also compared their findings with demographic and market trends linked with increases in joint replacement processes.
The study of CMS-Altarum recommends facilities that did face an increase in procedure volume during BPCI performance years did so due to the market forces, not the program. In few cases, it was because of the hospital consolidation, in others an increase in procedure volume was because of a growth and development in the Medicare population.
The authors summarized, "[O]ur study surely disputes any assertion that the BPCI-participating hospitals contributed to a higher volume of procedures as an outcome of that participation. In fact, the opposite is true. The rate of increase in the volume of procedures was majorly lower in contrast to the rest of the country. These findings point to the potential of bundled payment to make better quality and lower costs of care while maintaining or lowering/reducing the volume of the episodes of care."