Effect of Implementing a Bundled-Payment Program for Heart Failure at a Safety-Net Community Hospital.

Safety net community hospitals face unique challenges when entering risk-based contracts. The financial viability of such programs in these settings has not been well studied. This study analyzed a bundled-payment program for congestive heart failure at one such facility. To assess financial performance, the authors calculated the net patient payment by quarter after bundle implementation, and also compared the leading cost drivers before and after bundle implementation, specifically the next site of care and readmission rate. After 21 months of participating in the bundle, the program has saved money, been financially feasible, and generated positive returns for the hospital. Admission to skilled nursing facilities decreased from 21.3% to 16.0% after bundle implementation. The readmission rate was not significantly different, but trended downward. This study shows that safety net community hospitals can successfully participate in a bundled-payment program. For heart failure patients, decreasing admission to skilled nursing facilities and lowering the readmission rate are essential for program success.