The Effect of Bundled Payment on Emergency Department Use: Alternative Quality Contract Effects After Year One
Sharp, Adam L.; Song, Zirui; Safran, Dana G.; Chernew, Michael E.; Fendrick, A.
2013-09
Citation
Sharp, Adam L.; Song, Zirui; Safran, Dana G.; Chernew, Michael E.; Fendrick, A. (2013). "The Effect of Bundled Payment on Emergency Department Use: Alternative Quality Contract Effects After Year One." Academic Emergency Medicine (9): 961-964.
Abstract
ObjectivesThe objective was to identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield (BCBS) of Massachusetts in 2009, on emergency department (ED) presentations.MethodsBlue Cross Blue Shield of Massachusetts claims from 2006 through 2009 for 332,624 enrollees whose primary care physicians (PCPs) enrolled in the AQC, and 1,296,399 whose PCPs were not enrolled in the AQC, were evaluated. A pre–post, intervention–control, propensity‐scored difference‐in‐difference approach was used to isolate the AQC effect on ED visits. The analysis adjusted for age, sex, health status, and secular trends to compare ED use between the treatment and control groups.ResultsOverall, secular trends showed that the number of ED visits decreased slightly for both treatment and control groups. The adjusted analysis of the AQC group showed decreases from 0.131 to 0.127 visits per member/quarter, and the control group decreased from 0.157 to 0.152 visits per member/quarter. The difference‐in‐difference analysis showed the AQC had no statistically significant effect on total ED use compared to the control group.ConclusionsIn the first year of this AQC, we did not find evidence of change in aggregate ED use. Similar global budget programs may not alter ED use in the initial implementation period.ResumenEfecto del Pago Combinado en el Uso del Servicio de Urgencias: Los Efectos del Alternative Quality Contract tras un AñoObjetivosIdentificar el efecto del Alternative Quality Contract (AQC), un sistema de pago global implementado por el Blue Cross Blue Shield de Massachusetts en 2009, en las visitas a los servicios de urgencias (SU).MetodologíaSe evaluaron los 332.624 miembros cuyo médico de atención primaria (MAP) estaba incluido en el AQC y los 1.296.399 cuyo MAP no estaba incluido en el AQC del Blue Cross Blue Shield de Massachusetts de 2006 hasta 2009. Para identificar el efecto del AQC en las visitas al SU, se utilizó un diseño pre‐post, intervención‐control, con una aproximación por puntuación de propensión diferencia en diferencia. El análisis se ajustó por edad, sexo, estado de salud y tendencias seculares para comparar el uso del SU entre los grupos tratamiento y control.ResultadosDel total, las tendencias seculares mostraron que el número de visitas al SU descendió discretamente tanto para el grupo tratamiento como control. El análisis ajustado del grupo AQC mostró un descenso de 0,131 a 0,127 visitas por miembro/cuartil, y el grupo control descendió de 0,157 a 0,152 visitas por miembro/cuartil. El análisis de diferencia en diferencia mostró que el AQC no tuvo efecto estadísticamente significativo en el uso total del SU en comparación con el grupo control.ConclusionesEn su primer año, el AQC no tuvo un efecto significativo en el uso del SU. PLos programas económicos globales similares pueden no alterar la utilización del SU en el periodo inicial de implementación.Publisher
University of California Press Wiley Periodicals, Inc.
ISSN
1069-6563 1553-2712
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