Newtown, CT – February 10, 2017
For many years opponents of bundled payment programs have based one of their arguments against this mode of payment on the potential for participants to artificially produce more episodes of care. This week we debunk that myth – In a national study published earlier this week we show that there is no evidence that facilities that have been participating in Medicare’s Bundled Payment for Care Improvement increased the volume of procedures as a result of their participation. This theory had already been debunked in a paper published last year in JAMA, but some chose to ignore the finding, preferring to advance the fuzziest of math to back up a false claim. So we looked at all of the Medicare discharges for joint replacements, in all of the hospitals in the US over 5 years, to better understand what factors could potentially explain the differences in procedure prevalence, and changes over time. In addition to participation in BPCI, we also looked at the penetration of Medicare Advantage, differences in average age, gender and race. And we looked at market concentration. While there are factors that explain the differences in volume, BPCI isn’t one of them, but that’s just the start of the story.
What this means to you – Prior research looking at these various market effects have revealed that the prevalence of procedures in a Medicare population varies according to Medicare Advantage penetration. The greater the number enrolled in MA, the lower the procedure rate. Prior research has also shown lower prevalence of these procedures in African Americans. And a lot of research has shown that when there is excess supply in the market, the rate of procedures increases. We’ve now affirmed these findings quite definitively. Is there any evidence that shifting from fee-for-service to episode of care payment for procedures increases the volume of procedures? No. But there is a lot of research that shows how paying an episode of care reduces costs and improves patient quality. And yet those who have, for years, advocated that the only payment solution that can achieve lower costs and higher quality is total cost of care, continue to deny the evidence. And it’s somewhat ironic and funny to now see them accuse others of doing the same. To be clear, any payment model can create incentives that pull clinicians away from doing what’s right for patients, and as payment innovation continues to progress, we must stay vigilant, learn and adapt. But what we shouldn’t do is continue to deny facts because it fits a narrative. And for those who publish studies with fuzzy math simply to create some level of controversy that may increase viewership and therefore ad dollars, shame on you, for you’re supposed to be the neutral arbiters of evidence. At a time when media objectivity is an oxymoron, let’s hope that peer-reviewed journal objectivity doesn’t become one as well. We’ll be watching.