Hospitals participate more in CMS' bundled payments program when they have consultants

Katie Adams - Print  | 

Hospital partnerships with private consulting firms lead to greater participation in CMS' Bundled Payments for Care Improvement Advanced program, according to a study published in the August issue of Health Affairs.

The BPCIA program is a voluntary Medicare bundled payment model in which CMS sets benchmarks for spending on specific clinical episodes. If a hospital spends less than a benchmark for a clinical episode, it gets a reward, but if it spends more, it must pay a penalty.

When a hospital partners with a third-party consulting firm for the BPCIA program, they both share the program's financial risk. 

The study examined Medicare fee-for-service claims for beneficiaries who were discharged between Jan. 1, 2013, and Sept. 30, 2016, using a sample that included 2,988 hospitals across 28 BPCIA inpatient clinical episodes. 

Among hospitals participating in at least one of the program's clinical episodes, hospitals that partnered with consulting firms were more likely to select episodes with higher target prices. Additionally, hospitals that partnered with consulting firms were more likely than those that didn't to select clinical episodes with better opportunities to reduce spending on postacute care and readmissions.

Hospitals that partnered with consulting firms also participated in more of the program's clinical episodes than those that didn't.

The study also found that teaching and nonprofit hospitals were less likely to partner with consulting firms for the BPCIA program. 

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