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Association of Medicare's Bundled Payments for Care Improvement initiative with patientreported outcomes

Objective: To determine whether the Bundled Payments for Care Improvement (BPCI) initiative affected patientreported measures of quality.

Data Sources: Surveys of Medicare feeforservice beneficiaries discharged from acute care hospitals participating in BPCI Model 2 and comparison hospitals between October 2014 and June 2017. Variables from Medicare administrative data and the Provider of Services file were used for sampling and risk adjustment.

Study Design: We estimated riskadjusted differences in patientreported measures of care experience and changes in functional status, for beneficiaries treated by BPCI and comparison hospitals.

Data Collection: We selected a stratified random sample of BPCI and matched comparison beneficiaries. We fielded nine waves of surveys using a mail and phone protocol, yielding 29 193 BPCI and 29 913 comparison respondents.

Principal Findings: Most BPCI and comparison survey respondents reported a positive care experience and high satisfaction. BPCI respondents were slightly less likely than comparison respondents to report positive care experience or high satisfaction. Despite these differences in care experience, there was no difference between BPCI and comparison respondents in selfreported functional status approximately 90 days after hospital discharge.

Conclusions: These findings reduce concerns that BPCI may have unintentionally harmed patient health but suggest room for improvement in patient care experience.

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