Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

Abstract

Background Bundled payment models for lower extremity total joint arthroplasty (TJA) aim to improve value by decreasing costs via efficient care pathways. It is unclear how such models affect patient-centered outcomes such as functional recovery. We aimed to determine whether participation in bundled payment for TJA negatively affects patients’ functional recovery. Methods All patients, regardless of payer, undergoing elective TJA between July 2014 and December 2016 were identified retrospectively and categorized into prebundle (n = 680) and postbundle (n = 1216) cohorts. Mixed-effects linear regression and Wald postests were used to test for differences in patients’ functional recovery during the hospital period and over 12 months after TJA between cohorts. We also used multivariate regression to test for differences in hospital length of stay (LOS) and postacute care (PAC) facility use between cohorts. Results Compared with the prebundle cohort, patients in the postbundle cohort demonstrated a small and nonmeaningful difference in the trajectory of functional recovery in the hospital [χ 2 (3) = 31.3, P < .01] and no difference in the 12 months after TJA [χ 2 (3) = 3.9, P = .28]. They had a 0.4-day shorter hospital LOS (95% confidence interval: −0.5, −0.3) and decreased odds for PAC facility use (adjusted odds ratio = 0.3; 95% confidence interval: 0.2, 0.4). Conclusions Participation in bundled payment for TJA was not associated with significant changes in patients’ functional recovery, an important patient-centered outcome. For the postbundle cohort, hospital LOS and PAC facility use were decreased, consistent with previous studies describing cost-saving strategies in bundled payment. These findings support the need for an ongoing study of the long-term sustainability of these value-based payment models.

Value-Based Healthcare Initiatives in Practice: A Systematic Review

“…However, these opportunities for future cost savings are not measured by accurate costs and economical methods ( Etges et al, 2020 ). Two studies ( Johnson et al, 2019 ; van Deen et al, 2017 ) identified neutral effects or were not able to consistently observe improved results even though they showed these effects as potential improvements.…”

Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home

“…Similar outcomes have been observed for patients treated by PTs in the hospital for hip fracture44,45 and following elective spine surgeries 46. Bundling payments for acute and postacute care following total joint arthroplasty has served as a catalyst to change PT practice patterns and is associated with decreased hospital length of stay, fewer discharges to postacute care facilities, and noninferior functional outcomes 27,43,47…”

“…46 Bundling payments for acute and postacute care following total joint arthroplasty has served as a catalyst to change PT practice patterns and is associated with decreased hospital length of stay, fewer discharges to postacute care facilities, and noninferior functional outcomes. 27,43,47 Implementing bundled payment programs and other alternative payment strategies more broadly may serve to realign incentives in other patient populations. Such models contribute to hospitals prioritizing patients' discharge home to avoid costly facility-based postacute care.…”

Does value-based healthcare support patient-centred care? A scoping review of the evidence

“…Full-text screening resulted in the inclusion of 39 papers, all describing a unique study (figure 1). 19–57 Of these papers, 29 studies had been performed in the USA, 5 in the Netherlands, 3 in the UK, 1 in China and 1 in Italy (online supplemental table 1).…”

“…Miao et al showed that the implementation of a value-based payment programme led to a significant decrease in out of-pocket expenditure, also matching with the ‘Biopsychosocial’ dimension of patient-centredness 47. Johnson et al showed that the implementation of a bundled payment programme led to a small significant improvement in clinician ratings of patient’ mobility, that did not sustain over time, and was not accompanied with a difference in patient-reported functional recovery 41…”