# The effects of bundled payment on acute cardiovascular outcomes among older adults

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $520,291

## Abstract

PROJECT SUMMARY
Coronary artery disease causes over 360,000 annual deaths, primarily among older adults, and over $100
billion in medical expenditures. Despite improvements in outcomes, treatment remains beset by unwarranted
variation in care coupled with underuse of high-value care. To address these problems, CMS has introduced
several bundled payment reforms focused on cardiac procedures, including PCI and CABG. The most recent
program – Bundled Payment for Care Improvement Advanced (BPCI-A) – is a voluntary program that creates
incentives for hospitals to improve patient outcomes and reduce spending across a 90-day post-discharge
episode. Despite the promise of bundled payment, its effects on outcomes for common cardiac procedures are
not well understood. Incentives to improve care coordination and quality may encourage hospitals to reduce
periprocedural complications and tightly manage post-acute care referrals. At the same time, incentives to
reduce spending may encourage hospitals to avoid higher severity patients. In this context, we propose the
following aims: Aim 1. Evaluate the role of hospital and patient selection related to PCI and CABG episodes in
BPCI-A. We will link hospital participation in BPCI-A with Medicare data and data from the CathPCI and
Society of Thoracic Surgeons Adult Cardiac Surgery registries. We will compare hospital and patient severity
profiles with claims alone (the status quo in BPCI-A) and claims supplemented with registry data (the gold
standard). We will then test whether hospitals with 1) lower claims-based severity compared to registry-based
severity were less likely to participate in BPCI-A; and 2) patients with lower claims-based severity became less
likely to be treated at participating hospitals after BPCI-A. Aim 2. Evaluate the effects of BPCI-A on
periprocedural and post-discharge outcomes. Using Medicare claims and linked data from thousands of
hospitals participating in the registries, we will estimate econometric models to test whether BPCI-A was
associated with improvements in periprocedural complications and post-discharge outcomes. Aim 3. Evaluate
how changes in BPCI-A and delivery system disruptions from COVID-19 inform the future design of bundled
payment. We will exploit a change in the design of BPCI-A to examine whether including spending associated
with cardiac rehabilitation in the episode led to lower cardiac rehabilitation. We will also compare hospital
quality performance using claims-based and registry-based measures and test for shifts in patient severity
profiles for patients receiving inpatient and outpatient PCI. Finally, we will examine the accuracy of target
prices before and after COVID-19. This proposal is significant because it will be the first to understand the
effects of BPCI-A on selection and outcomes for cardiac procedures using high quality registry data. The
proposal is innovative in its use of novel data linkages and statistical methods to understand the impact of t...

## Key facts

- **NIH application ID:** 10440026
- **Project number:** 2R01AG047932-06A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Andrew M Ryan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $520,291
- **Award type:** 2
- **Project period:** 2015-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10440026

## Citation

> US National Institutes of Health, RePORTER application 10440026, The effects of bundled payment on acute cardiovascular outcomes among older adults (2R01AG047932-06A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10440026. Licensed CC0.

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