Some policymakers, arguing that mandatory bundled-payment programs disadvantage some hospitals, have called for these programs to be strictly voluntary. A recent study, however, found no evidence that hospitals in the mandatory program were obviously disadvantaged compared to their voluntary counterparts.

In the study, published recently in Health Affairs, researchers from the University of Pennsylvania School of Medicine used data from the American Hospital Association and the Centers for Medicare and Medicaid Services. They compared organizational characteristics and measures of costs and care quality for 302 hospitals in the voluntary bundled-payment joint-replacement program (“Bundled Payments for Care Improvement”) and 799 in the mandatory program (“Comprehensive Care for Joint Replacement”).

Larger, non-profit hospitals tend to participate in voluntary Medicare bundled payment programs, whereas some hospitals with lower volumes and fewer resources might only participate under a mandatory program.

The researchers found no large differences in baseline spending, care quality, or financial risk exposure for voluntary versus mandatory program hospitals, according to a media release from University of Pennsylvania School of Medicine.

“Our results suggest that both voluntary and mandatory approaches can play an important role in engaging hospitals across the country, so policymakers should not restrict policy options to one approach over the other,” says study lead author Amol S. Navathe, MD, PhD, an assistant professor in the department of Medical Ethics and Health Policy at Penn Medicine, in the release.

“The mandatory program does not seem to have disadvantaged its participants compared to voluntary participants on average, with respect to spending and care quality,” Navathe adds.

However, there were significant organizational differences between the two hospital groups. Those in the voluntary program were of course self-selected; they were on average larger, and handled a greater volume of joint-replacement surgeries. What that means, though, is that hospitals in the voluntary program probably are not as representative of hospitals nationwide, the release explains.

“In other words, we think mandatory bundled-payment programs can produce more generalizable evidence of cost-savings,” Navathe adds.

“These emerging bundled-payment policies should engage a broad range of hospitals in order to bring cost savings and quality improvements to patients across the nation—and that is likely to require a mix of mandatory programs and additional targeted voluntary programs,” says study senior author Ezekiel J. Emanuel, MD, PhD, professor and chair of the department of Medical Ethics and Health Policy at Penn Medicine.

[Source(s): University of Pennsylvania School of Medicine, Science Daily]