Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care

Abstract

ClinicalTrials.gov Identifier: NCT03407885; American Economic Association Registry Identifier: AEARCTR-0002521.

Post‐Acute Care After Joint Replacement in Medicare's Bundled Payments for Care Improvement Initiative

“…Prior single‐center studies of joint replacement under BPCI have suggested that savings accrue from reducing high‐cost institutional PAC care . Dummit et al found evidence of modest savings among BPCI participants compared to nonparticipants, as well as reduction in institutional PAC use and duration, and Finkelstein et al found similar patterns in CJR . CMS has released annual reports on BPCI performance, with similar findings for joint replacement .…”

“…[4][5][6][7][8]29 Dummit et al found evidence of modest savings among BPCI participants compared to nonparticipants, as well as reduction in institutional PAC use and duration, 10 and Finkelstein et al found similar patterns in CJR. 3 CMS has released annual reports on BPCI performance, with similar findings for joint replacement. [11][12][13][14] The estimates from our work are qualitatively similar, though not identical, to previously published work.…”

“…If spending targets are achieved, the participant can keep part of the savings; if targets are exceeded, the hospital is responsible for a portion of the difference. The Centers for Medicare and Medicaid Services (CMS) launched a follow‐on version of BPCI called BPCI‐Advanced in October 3, 2018 CMS also administers a partially mandatory bundled payment program called Comprehensive Joint Replacement …”

“…The Centers for Medicare and Medicaid Services (CMS) launched a follow-on version of BPCI called BPCI-Advanced in October 3, 2018 CMS also administers a partially mandatory bundled payment program called Comprehensive Joint Replacement. 3 While the cost of the index hospitalization is generally the largest component of a bundle, PAC, which includes skilled nursing facility (SNF), home health agency (HHA), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) services, is the second-largest cost driver, and the largest source of variability in costs among different providers. [4][5][6][7][8][9] Indeed, prior work has shown that institutional PAC (SNF/IRF/LTCH) was reduced under a bundle for major joint replacement of the lower extremity (MJRLE).…”

Trends in Postacute Care Use and Outcomes After Hip and Knee Replacements in Dual-Eligible Medicare and Medicaid Beneficiaries, 2013-2016

“…Hip and knee replacements are the most common inpatient procedures performed for older Medicare beneficiaries (eg, >400 000 procedures in 2014) 1 and have been recently targeted by Medicare alternative payment models for improved quality and efficiency of care. [1][2][3] Although most patients are discharged home after hip and knee replacements (possibly with some form of home health care), about 30% are discharged to postacute care (PAC) facilities, most commonly skilled nursing facilities (SNFs), to help optimize functional recovery. 4 Postacute care practices after replacement procedures vary substantially [4][5][6][7] owing to lack of consensus on the optimal setting and intensity of PAC, and owing to different Medicare reimbursement approaches for alternative PAC.…”