Institutional post-acute care (PAC) is a significant area for cost savings in alternative payment models (APMs). While APMs can reduce PAC utilization, the impact of hospital skilled nursing facility (SNF) integration on voluntary APM participation is unclear.

A recent study in JAMA Network Open led by Jason Buxbaum, PhD, a Department of Health Care Policy alumnus and current Assistant Professor at the Brown School of Public Health, in collaboration with HCP faculty members David C. Grabowski, PhD, Michael E. Chernew, PhD, and Laura A. Hatfield, PhD, examined this relationship using Bundled Payments for Care Improvement Advanced (BPCI-A) data.

Key Findings from the Study:

• Uneven Association: The study revealed a varying impact of hospital-SNF integration on BPCI-A participation across different episodes of care.
• MJRLE Episode: Hospital-SNF integration was associated with a significant decrease in participation for the major joint replacement of the lower extremity (MJRLE) episode. This suggests that hospitals and SNFs already integrated might have been less incentivized to join BPCI-A, potentially due to concerns about revenue loss for this high-volume episode.
• No Detectable Association for Other Episodes: Integration was not demonstrably associated with participation in the hip and femur procedures (HFP), sepsis, or stroke episodes. 

Taken together, findings suggest that factors like organizational characteristics and episode-specific considerations may be more important than integration in influencing participation in voluntary APMs. To promote wider adoption of APMs, policymakers should focus on understanding these factors and providing targeted support or incentives to hospitals and SNFs.  Policymakers should also give consideration to mandatory APMs, such as the recently announced Transforming Episode Accountability Model (TEAM).

Future research should focus on longitudinal studies to track changes in integration and other factors over time. Qualitative research can provide deeper insights into the decision-making processes of hospital and SNF leaders regarding voluntary APM participation. Comparative analysis can help identify regional variations and the factors driving participation in different contexts.

Through further investigation in these areas, researchers can develop a more comprehensive understanding of the factors influencing hospital-SNF integration and voluntary APM participation, ultimately informing policies aimed at improving healthcare quality and reducing costs.