April 12, 2017
Recent research in JAMA Internal Medicine showed that hospitals that voluntarily participated in CMS value-based care models reduced readmissions better than hospitals not participating in value-based care.
“The US health care system is experiencing rapid change. Persistently high spending and variable population health outcomes have driven US policymakers to experiment with different approaches to care delivery and payment,” Andrew M Ryan, PhD, of the department of health management and policy at the University of Michigan School of Public Health, and colleagues wrote. “We [evaluated] whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare’s Hospital Readmission Reduction Program (HRRP).”
In order to determine the impact of value-based care models on readmission rates, the researchers used hospital readmissions data from Hospital Compare to conduct a retrospective, longitudinal study. They studied data from 2837 hospitals from between 2008 and 2015. They analyzed how participation in 3 models affected readmissions, including the Meaningful Use of Electronic Health Records, the Bundled Payment for Care Initiative episode-based payment program (BPCI), and the Medicare Pioneer and Shared Savings accountable care organization (ACO) programs. Data included 30-day readmission rates for heart attack, heart failure, and pneumonia.
Participation in value-based care varied widely across the study hospitals. They found that while in 2010, no hospitals were participating in any of the three models, by 2015 all but 56 of the hospitals were participating in at least one of the three study models.
Study results showed that participation in value-based care was associated with reductions in 30-day readmission rates that were greater than those found in hospitals participating in HRRP standards alone.
Dr Ryan and colleagues noted that participation in value-based models was associated with significant cost savings.
“The impact of hospital participation in these voluntary reforms is substantial,” they wrote. “Combining our estimates with published figures on the number of readmissions and Medicare spending per readmission, we estimate that, across the three targeted diagnoses, in 2015 hospital participation in meaningful use, ACOs, and BPCI programs led to 2377 fewer readmissions saving Medicare $32,746,283”
The researchers concluded that participation in value-based models may have improved hospital infrastructure and increased focus on reducing readmissions.
“Our results help to address the question of how multiple programs focused on increasing hospital value interact,” Dr Ryan and colleague concluded. “These findings lend support for CMS’ multipronged strategy to improve hospital value.”—David Costill