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A2509 - Healthcare Costs in a Bundle Payment for Care Improvement Model for Asthma and COPD Hospitalizations: A Pilot Study of Patient Engagement
Author Block: A. S. Iyer1, K. N. Bridges2, L. Z. Hoyle2, d. P. Kirkpatrick1, C. C. Blackburn1, L. T. Leach2, T. Parekh1, J. F. Detelich2, S. P. Bhatt1, M. T. Dransfield3, J. M. Wells1; 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 2University of Alabama at Birmingham, Birmingham, AL, United States, 3Pulmonary, Allergy, Critical Care Medicine, UAB, Birmingham, AL, United States.
Background: As bundled payment for care improvement (BPCI) initiatives become more prevalent, hospitals are experiencing greater pressure to reduce costs post-acute care. Lack of patient engagement has been previously associated with excess healthcare costs. We hypothesized that poor patient engagement would be associated with costs that exceeded the target episode price as assigned by the BPCI bundle for asthma or chronic obstructive pulmonary disease (COPD).
Methods: Medicare patients discharged from our hospital between October 2014 and June 2016 who were assigned a diagnosis-related group (DRG) code for COPD (190, 191, 192) or asthma (202, 203) were included in the analysis. A care transitions nurse ascertained patient engagement at the time of discharge by assigning patients to 1 of 4 levels of patient engagement, with higher scores indicating more complete engagement. The estimated Medicare BPCI target price was established by Medicare and was based on the DRG assigned to the patient at discharge and included all costs incurred through 90-days post-discharge. Linear and logistic regression analyses were used to measure associations between engagement, costs, and clinical characteristics.
Results: During the pilot period, 72 patients were enrolled in the BPCI. Patients were 68±14 years old, 43% male, had a median of 4 [IQR 3-6] comorbidities, and median engagement level of 2 [IQR 1-4] with 24 (33.3%) considered “poor engagement” (engagement level = 1). On average, participants were within 5% (range -57% to +250%) of target BPCI price. Patients with poor engagement exceeded the target BPCI price by 24% ($3,862, 95% CI $745-$6,979, P=0.016). A 1-point increase in engagement in engagement was associated with a lower price relative to the BPCI target price (β = -11.6, P=0.032). In a multivariable linear regression model, engagement was independently associated with the variance from the estimated BPCI price (β = -11.0, P=0.017) when adjusted for age, sex, CCI, and 90-day readmission status. Patient engagement was not associated with 90-day readmission (OR 0.89, 95% CI 0.58-1.38) in unadjusted analysis.
Conclusion: We identified patient engagement as a potentially modifiable target to improve care delivery and reduce costs among patients enrolled in an asthma or COPD BPCI model. Our results challenge the singular focus on reducing the readmission rate following a COPD or asthma exacerbation. Future studies should be aimed at improving the recognition of poor engagement and developing strategies to improve engagement in this population.