Differential Hospital Participation in Bundled Payments in Communities with Higher Shares of Marginalized Populations

Aidan P. Crowley, Sarah Neville, Chuxuan Sun, Qian Erin Huang, Deborah Cousins, Torrey Shirk, Jingsan Zhu, Austin Kilaru, Joshua M. Liao, Amol S. Navathe

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Medicare’s voluntary bundled payment programs have demonstrated generally favorable results. However, it remains unknown whether uneven hospital participation in these programs in communities with greater shares of minorities and patients of low socioeconomic status results in disparate access to practice redesign innovations. Objective: Examine whether communities with higher proportions of marginalized individuals were less likely to be served by a hospital participating in Bundled Payments for Care Improvement Advanced (BPCI-Advanced). Design: Cross-sectional study using ordinary least squares regression controlling for patient and community factors. Participants: Medicare fee-for-service patients enrolled from 2015–2017 (pre-BPCI-Advanced) and residing in 2,058 local communities nationwide defined by Hospital Service Areas (HSAs). Each community’s share of marginalized patients was calculated separately for each of the share of beneficiaries of Black race, Hispanic ethnicity, or dual eligibility for Medicare and Medicaid. Main Measures: Dichotomous variable indicating whether a given community had at least one hospital that ever participated in BPCI-Advanced from 2018–2022. Key Results: Communities with higher shares of dual-eligible individuals were less likely to be served by a hospital participating in BPCI-Advanced than communities with the lowest quartile of dual-eligible individuals (Q4: -15.1 percentage points [pp] lower than Q1, 95% CI: -21.0 to -9.1, p < 0.001). There was no consistent significant relationship between community proportion of Black beneficiaries and likelihood of having a hospital participating in BPCI-Advanced. Communities with higher shares of Hispanic beneficiaries were more likely to have a hospital participating in BPCI-Advanced than those in the lowest quartile (Q4: 19.2 pp higher than Q1, 95% CI: 13.4 to 24.9, p < 0.001). Conclusions: Communities with greater shares of dual-eligible beneficiaries, but not racial or ethnic minorities, were less likely to be served by a hospital participating in BPCI-Advanced Policymakers should consider approaches to incentivize more socioeconomically uniform participation in voluntary bundled payments.

Original languageEnglish (US)
Pages (from-to)1180-1187
Number of pages8
JournalJournal of general internal medicine
Volume39
Issue number7
DOIs
StatePublished - May 2024

Keywords

  • alternative payment models
  • bundled payments
  • health equity

ASJC Scopus subject areas

  • Internal Medicine

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