TOPLINE:
Hospital participation in Medicare's bundled payments for care improvement (BPCI) model 2 program for heart failure (HF) was not associated with significant improvements in quality performance measures or 30- and 90-day readmission and mortality rates, new observational data showed.
METHODOLOGY:
- The retrospective cohort study used data from the American Heart Association (AHA) Get With The Guidelines-HF (GWTG-HF) registry linked to Medicare claims.
- Participants included 8721 patients hospitalized with HF at 18 hospitals participating in the BPCI advanced model 2 program and 94,530 peers from 224 same-state non-BCPI hospitals.
- Primary endpoints included seven quality-of-care measures; secondary endpoints included nine outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30- and 90-day all-cause readmission and mortality rate.
TAKEAWAY:
- There was no significant difference in providing guideline-directed medical therapy for HF at discharge between BPCI and non-BPCI hospitals, except for a decreased odds of receiving a beta-blocker at discharge at BPCI hospitals.
- BPCI participation was not associated with a significant change in the odds of receiving at discharge an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, angiotensin receptor-neprilysin inhibitor, aldosterone antagonist, cardiac resynchronization therapy (CRT)-defibrillator or CRT pacemaker, implantable cardioverter-defibrillator counseling or placement/prescription, HF education, or a follow-up visit within a week.
- There was a lower risk for in-hospital mortality (adjusted odds ratio, 0.67; P = .002) at BPCI hospitals but no change in 30- or 90-day risk-adjusted all-cause mortality or readmission rates.
IN PRACTICE:
"The BPCI advanced model was launched in October 2018 with the goal of enhancing care coordination, reducing cost, and improving quality of care. Unlike the original, BPCI advanced incorporates a direct quality incentive," the authors wrote. Based on their findings, "revision of the BPCI program is needed to better coordinate care, improve quality of care, and reduce healthcare expenditures."
SOURCE:
The study, with first author D. August Oddleifson, MD, MBA, Beth Israel Deaconess Medical Center, Boston, Massachusetts, was published online on January 3, 2024, in JAMA Cardiology.
LIMITATIONS:
The sample included only a small subset of 18 hospitals participating in the BPCI for HF program. The potential exists for residual measured and unmeasured confounding variables that could influence the findings. Other aspects of care quality and other patient-centered outcomes such as health status or home time were not analyzed. It was not possible to examine post-acute care selection and duration.
DISCLOSURES:
Several authors reported various relationships to the pharmaceutical industry, which are listed with the original article. The study had no specific funding. The AHA GWTG-HF program was supported in part by Novartis, Boehringer Ingelheim, Novo Nordisk, AstraZeneca, Bayer, Tylenol, and Alnylam Pharmaceuticals.
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