CMS’s voluntary bundled payment evaluation finds uneven results

The evaluation of models 2-4 of Medicare’s Bundled Payments for Care Improvement (BPCI) initiative highlighted mixed results on savings and quality in the first 15 months of the program.

Patrick Conway, MD, acting principal deputy administrator and chief medical officer for CMS, was optimistic about the results of the experience of participants through June 2015. In a blog post, he pointed to how “11 out of the 15 clinical episode groups analyzed showed potential savings to Medicare.”

“Early results are encouraging: orthopedic surgery bundles, in particular, have shown promising results on cost and quality in the first two years of the initiative,” Conway wrote. “These models keep the patient at the center of care delivery and focus on well-coordinated, high quality care.”

According to the evaluation, orthopedic surgery under Model 2 hospitals showed savings of $864 per episode while also improving 90-day post-discharge scores on mobility under surveys of beneficiaries.  

For cardiovascular episodes at Model 2 hospitals, Conway said no savings were shown but quality scores didn’t decline.

On the negative side, however, the evaluation said average payments for spinal surgery episodes increased $3,477 more than comparison providers, which the report said “warranted further investigation.”

Future evaluations may be more indicative of the effects on cost and quality, as sample sizes will be much larger with more participants joining the program in the past year. The report warned against “generalizing these results to other providers or the full range of clinical episodes.”

“The study reflects, at most, the first 15 months of experience of the earliest BPCI participants,” the evaluation said. “Because of limited sample sizes, we are not able to report on the experience of each combination of Model/participant type/ clinical episode group. Limited sample sizes, in particular, have affected our ability to understand the differential impact of BPCI across types of participants, health care delivery, and the Medicare program.”