Bundled payments for outpatient spinal surgery linked to reduced cost, readmittance

Key takeaways:

• Hospital participation in BPCI Advanced reduced total episode spending for outpatient surgery.
• Inpatient procedures were not associated with differential changes in total episode spending or readmissions.

Bundling payments for outpatient spinal surgery was associated with reductions in cost and fewer readmissions, according to data reported at the American Association of Neurological Surgeons Annual Scientific Meeting.

“This study is one of the first to evaluate value-based care (specifically bundled payments) for outpatient surgery,” Grace Y. Ng, MD, MS, neurosurgery resident at Massachusetts General Hospital, told Healio.

“There has been an increasing shift from inpatient to outpatient surgery and it is important to understand how health systems are adapting to this change and working to improve value in this setting,” Ng said.

In 2018, CMS introduced Bundled Payments for Care Improvement – Advanced (BPCI Advanced), the first episode-based payment model to include spinal surgery as an outpatient condition.

Ng and colleagues sought to analyze spending and quality for outpatient compared with inpatient surgical bundles and to determine if hospital participation in BPCI Advanced for outpatient and inpatient spine surgery (back and neck except spinal fusion procedures, BNESF) was associated with changes in spending and quality.

Their retrospective observational study culled data from Medicare claims and differences-in-differences analysis adjusting for patient and market characteristics. A total of 14,280 individuals who received outpatient BNESF and 23,400 patients who received inpatient BNESF between 2013 and 2019 at hospitals that participated in BPCI Advanced were paired with a matched comparison cohort of patients at non-participating hospitals.

The study’s primary outcome was total episode spending, including costs incurred for the index procedure and 90-day follow-up period, while secondary outcomes included 90-day readmissions, ED visits and overall mortality.

Ng and colleagues reported that hospital participation in BPCI Advanced was associated with a differential reduction in total episode spending (-$1,201 [95% CI: -2,184 to -219]) and readmissions (-2.2 percentage points [95% CI: -4.2 to -0.1) for outpatient BNESF.

Conversely, for inpatient BNESF, hospital participation in BPCI Advanced was not associated with differential changes in total episode spending or readmissions.

Data additionally showed no significant changes for ED visits or mortality for either group.

“We found that hospitals participating in bundled payments for outpatient surgery achieved reductions in cost and readmissions,” Ng told Healio. “This is an exciting finding that suggests value-based care initiatives may be effective not only for inpatient, but also outpatient surgical settings.”

For more information:

Grace Y. Ng, MD, MS, can be reached at neurology@healio.com.