Spending And Quality After Three Years Of Medicare’s Voluntary Bundled Payment For Joint Replacement Surgery

Navathe, Amol S.; Emanuel, Ezekiel J.; Venkataramani, Atheendar S.; Huang, Qian; Gupta, Atul; Dinh, Claire; Shan, Eric; Small, Dylan S.; Coe, Norma B.; Wang, Erkuan; Ma, Xinshuo; Zhu, Jingsan; Cousins, Deborah; Liao, Joshua M.

doi:10.1377/hlthaff.2019.00466

Cited by 54 publications

(72 citation statements)

References 18 publications

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“…Fourth, our results reinforce existing evidence151718192036 that in achieving cost savings, participation in bundled payments does not appear to worsen quality. Although these findings are reassuring, more work is needed to fully understand the impact of practice changes in post-acute care use, including when unintended consequences such as increased readmissions might occur.…”

Section: Discussionsupporting

confidence: 86%

“…First, the association between medical bundles and long term savings is reassuring to policy makers in both the US and internationally who are pursuing bundles as a cost containment strategy 10. In particular, decision makers should be encouraged by the 1-2% savings for episodes achieved under medical bundles, which complement the 2-4% savings for episodes observed under surgical bundles 8111315171819203637…”

Section: Discussionmentioning

confidence: 99%

“…Covariates were chosen based on previous studies 111316363738. Patient level covariates included age, sex, race, disability status, Medicare and Medicaid dual eligibility status, Elixhauser comorbidities, and admission diagnosis related group 39.…”

Section: Methodsmentioning

confidence: 99%

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Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Rolnick

Liao

Emanuel

et al. 2020

BMJ

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ObjectiveTo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DesignQuasi-experimental difference-in-differences analysis.SettingUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.Participants238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.Main outcome measuresPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.ResultsIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change −0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (−1.2%, 95% confidence interval −2.3% to −0.2%). Spending on care at skilled nursing facilities decreased (−6.3%, −10.0% to −2.5%) owing to a reduced number of facility days (−6.2%, −9.8% to −2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (−0.1 percentage points, 95% confidence interval −0.5 to 0.2 percentage points).ConclusionsIn this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Rolnick

Liao

Emanuel

et al. 2020

BMJ

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“…Changes in patient selection may play a large role in cost savings in bundled payment programs, for example. 10 Quality improvement or other initiatives may also have played a role in changing both postacute care use and outcomes. Given concerns regarding unmeasured confounding, we caution against interpreting findings as demonstrating reduced harm; rather, we interpret these findings as not showing an association with increased harm when institutional postacute care use is reduced.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Early evaluations of these individual programs have not shown evidence of harm, even in frail LEJR populations, although long-term effects remain unstudied. 4 , 6 , 10 , 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Association of Discharge to Home vs Institutional Postacute Care With Outcomes After Lower Extremity Joint Replacement

et al. 2020

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Key Points Question How have clinical outcomes changed for adults undergoing lower extremity total joint arthroplasty whose postdischarge care has shifted from institutional postacute care settings to home because of changes in financial incentives? Findings This cohort study of 189 949 adult patients who underwent lower extremity joint replacement procedures in Pennsylvania used a matched difference-in-differences approach. Adults discharged home between 2016 and 2018 had fewer hospital readmissions than propensity-matched adults who had been discharged to institutional postacute care between 2011 and 2013, but no differences in surgical complications or mortality were observed. Meaning In this study, there was no association with worsening outcomes for adults who were discharged home following joint arthroplasty and were clinically similar to patients discharged to institutional postacute care before financial incentives changed.

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Association Between Hospital Voluntary Participation, Mandatory Participation, or Nonparticipation in Bundled Payments and Medicare Episodic Spending for Hip and Knee Replacements

Liao

Gupta

Zhao

et al. 2021

JAMA

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Spending And Quality After Three Years Of Medicare’s Voluntary Bundled Payment For Joint Replacement Surgery

Cited by 54 publications

References 18 publications

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Association of Discharge to Home vs Institutional Postacute Care With Outcomes After Lower Extremity Joint Replacement

Association Between Hospital Voluntary Participation, Mandatory Participation, or Nonparticipation in Bundled Payments and Medicare Episodic Spending for Hip and Knee Replacements

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