Medicare readmission rates vary widely among BPCI Advanced conditions: 4 takeaways

The 90-day Medicare readmission rates for certain conditions in the Bundled Payments for Care Improvement Advanced Model are as high as 43 percent and as low as 7 percent, according to a new analysis from health care consultant Avalere. 

BPCI Advanced, CMS' new voluntary program, was announced Jan. 9.  Initially it will include 32 clinical episodes, with some providers starting participation in selected episodes Oct. 1.

Given that readmission rates are one of the quality measures for BPCI Advanced, Avalere released its analysis of these rates for providers thinking about participating in the model.

Researchers used the Medicare Standard Analytic 5 percent claims file for 2016 through the third quarter of 2017 to examine clinical care episodes for BPCI Advanced conditions. Readmission rates for 2017 were determined through the examination of how many episodes had at least one readmission within the episode.

Here are four takeaways from the analysis:

1. The readmission rate for liver disorders except malignancy, cirrhosis or alcoholic hepatitis was highest among the BPCI Advanced conditions studied, at 43 percent.

2. The select liver disorders were followed by heart attack and congestive heart failure, which had readmission rates of 34 percent and 36 percent, respectively.

3, Certain BPCI Advanced conditions had readmission rates below 20 percent. These were pacemaker, coronary artery bypass graft surgery, combined anterior posterior spinal fusion, back and neck except spinal fusion, spinal fusion (noncervical), cervical spinal fusion, and certain joint replacements.

4. At the bottom of the list was major joint replacement of upper extremity with a readmission rate of 7 percent.


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