The first year of a bundled payment program for outpatient spine surgery was associated with lower spending compared to inpatient cases, according to a study published in JAMA Health Forum July 11.
Five things to know:
1. The cohort study used Medicare claims and differences-in-differences analysis. Outpatient and inpatient back and neck except spinal fusion patients between 2013 and 2019 were included.
2. A total of 14,280 patients were included in the study. The study measured total episode spending, including spending incurred for the index procedure and 90-day follow-up period. Secondary outcomes included 90-day return inpatient admissions, emergency department visits and mortality.
3. Bundled Payments for Care Improvement Advanced was associated with a differential reduction of $1,201 in total episode spending. Return inpatient admissions were 2.2% lower compared to hospitals that didn’t participate in bundles.
4. Of the 23,440 inpatient spine patients, hospital participation in bundles wasn’t associated with any changes in spending or rates of return inpatient admissions. There weren’t significant changes for emergency department visits or mortality for either group.
5. Researchers concluded that “participation in the first year of a bundled payment program for outpatient spine surgery was associated with nearly 10% lower spending. No changes in spending were observed for similar inpatient spine surgery procedures. Further evaluation of bundled payments for outpatient surgical conditions and associated changes in care delivery is needed to inform plans to include these episodes in future models.”
