{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:13:43Z","timestamp":1793124823213,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:sec id=\"ab-hoi230071-4\"><jats:title>Importance<\/jats:title><jats:p>The Centers for Medicare &amp;amp;amp; Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-5\"><jats:title>Objective<\/jats:title><jats:p>To compare changes in the quality and outcomes of care for patients hospitalized with heart failure according to hospital participation in the BPCI program.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study used a difference-in-difference approach to evaluate the BPCI program in 18 BPCI hospitals vs 211 same-state non-BPCI hospitals for various process-of-care measures and outcomes using American Heart Association Get With The Guidelines\u2013Heart Failure registry and CMS Medicare claims data from November 1, 2008, to August 31, 2018. Data were analyzed from May 2022 to May 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-7\"><jats:title>Exposures<\/jats:title><jats:p>Hospital participation in CMS BPCI Model 2 Heart Failure, which paid hospitals in a fee-for-service process and then shared savings or required reimbursement depending on how the total cost of an episode of care compared with a target price.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary end points included 7 quality-of-care measures. Secondary end points included 9 outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30-day and 90-day all-cause readmission rate and mortality rate.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-9\"><jats:title>Results<\/jats:title><jats:p>During the study period, 8721 patients were hospitalized in the 23 BPCI hospitals and 94\u202f530 patients were hospitalized in the 224 same-state non-BPCI hospitals. Less than a third of patients (30\u202f723 patients, 29.8%) were 75 years or younger; 54\u202f629 (52.9%) were female, and 48\u202f622 (47.1%) were male. Hospital participation in BPCI Model 2 was not associated with significant differential changes in the odds of various process-of-care measures, except for a decreased odds of evidence-based \u03b2-blocker at discharge (adjusted odds ratio [aOR], 0.63; 95% CI, 0.41-0.98; <jats:italic>P<\/jats:italic>\u2009=\u2009.04). Participation in the BPCI was not associated with a significant differential change in the odds of receiving angiotensin-converting enzyme inhibitors\/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)\u2013defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or having a follow-up visit within 7 days or less. Participation in the BPCI was associated with a significant decrease in odds of in-hospital mortality (aOR, 0.67; 95% CI, 0.51-0.86; <jats:italic>P<\/jats:italic>\u2009=\u2009.002). Participation was not associated with a significant differential change in hospital-level risk-adjusted 30-day or 90-day all-cause readmission rate and 30-day or 90-day all-cause mortality rate.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hoi230071-10\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>In this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2023.5009","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T16:02:35Z","timestamp":1704297755000},"page":"222","source":"Crossref","is-referenced-by-count":14,"title":["Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure"],"prefix":"10.1001","volume":"9","author":[{"given":"D. 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Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry A.","family":"Allen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center, Los Angeles"},{"name":"Associate Section Editor, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica S.","family":"Spatz","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"12","key":"hoi230071r1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004873","article-title":"National burden of heart failure events in the United States, 2006 to 2014.","volume":"11","author":"Jackson","year":"2018","journal-title":"Circ Heart Fail"},{"issue":"14","key":"hoi230071r2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016782","article-title":"Trends of clinical outcomes and health care resource use in 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