High readmission rates unlikely to deter bundled payment participation

Doctor talking to senior patient and her husband
Participants in the Trump administration's new bundled payment likely won't be scared away due to high readmission rates for some conditions. (Getty/olgachov)

Participants in a new voluntary bundled payment model will have a lot of work to do to bring down high readmission rates for certain conditions.

But that won't necessarily scare off prospective participants.

Analysis from Avalere Health found a wide variation of readmission rates among conditions covered under the Bundled Payments for Care Improvement (BPCI) Advanced model, which was announced by the Trump administration in January and will go into effect later this year.

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Readmissions rates are one of seven quality measures included in the program. Reducing such visits are a major goal of alternative payment models in general due to their high cost and unnecessity.

Avalere found readmission rates for certain liver disorders are as high as 43%, while surgical joint replacement readmissions were under 10%.

Fred Bentley, one of the authors of the report, told FierceHealthcare that some conditions, like liver disorders, result in high readmission rates due to medical complexity in such patients.

"Many of these patients have very serious and sometimes numerous conditions to manage," he said, adding that it may be difficult to get rates down for such conditions. "But it's amazing what can be done when providers start paying attention to care transition and patient education."

He added that surgical procedures would be the easiest to reduce readmission rates since they are easier to manage than complex chronic conditions.

While such high readmission rates might be daunting for some providers to take on, participation for the program should be strong, according to Bentley. That's due in part to a 5% bonus payment under the Medicare Access and CHIP Reauthorization Act.

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Participation rates under voluntary models have been historically low, with only 12% of eligible providers signing up for the original 2013 BPCI, and about half ended up dropping out. Bentley said the new model could see similar participation.

However, some researchers have pushed back against voluntary models and claim that such programs don't provide proper insight into whether a payment approach should be rolled out on a nationwide basis.

Participants have until August to decide whether to participate, with some providers beginning the program on Oct. 1.

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