A commentary in Medscape offers a second opinion on a recent study reporting the cost effectiveness of bundled care payments for COPD.
Let’s take a closer look at the numbers. I’ll start by taking issue with their cost analysis. In 2012 (historical control year) and 2014 (BCPI intervention year), UAB averaged 109 and 78 admissions for AECOPD, respectively. So, to manage 78 admissions per year, they needed one-and-a-half to two-and-a-half mid-level employees (nurses and nurse practitioners)? Having run two pulmonary services at two separate tertiary, academic medical centers, I would estimate that this task should occupy one mid-level nurse practitioner for only a portion of the given shift. At most. Even accounting for the extra BCPI initiatives, this individual’s involvement should decrease physician effort, not increase it. Last, printing flyers costs little, and education and telephone calls can be automated at minimal expense. In short, I think cost efficacy is underestimated in their analysis.
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