Joint Replacement Bundling May Boost Home Care Spending
New study shows BCPI bundling increases home health spending.
The forthcoming Comprehensive Care for Joint Replacement Model may be about to wreak havoc on home health agencies’ referral streams, but the overall effect could benefit the industry.
Recap: Under the CJR model, hospitals in nine states will see financial penalties if the average cost for Medicare post-acute services for their joint replacement patients exceed a target price set by Medicare (see program details, HCW Vol. XXV, No. 8). The CJR model follows a Bundled Payment For Care Initiative (BPCI) demonstration that has tested four models bundling hospital payments with those for post-discharge, outpatient and other services.
A new study published by the Kaiser Family Foundation finds that under the two BCPI models that include home health spending in the bundling, home health spending increased.
Under BCPI Model 2, “BPCI providers had greater declines in SNF and IRF spending along with increases in home health spending,” according to the article at http://kff.org/report-section/paymentand-delivery-system-reform-in-medicare-report.
Average episode payments were lower under that model when post-acute care was furnished. Under BPCI Model 3, home health spending increased for BCPI providers, but there was “no significant difference in change in average overall episode payments between BPCI providers and non-BPCI providers,” the KFF study says.
The study also examined other payment reform tests, including Medicare’s Independence at Home demonstration where patients receive primary care services in their own homes. “In the first year, the IAH model produced net Medicare savings totalling over $25 million,” the study says.
