Cost of Joint Replacement Using Bundled Payment Models

Published on Feb 1, 2017in JAMA Internal Medicine21.873
· DOI :10.1001/JAMAINTERNMED.2016.8263
Amol S. Navathe17
Estimated H-index: 17
(Leonard Davis Institute of Health Economics),
Andrea B. Troxel85
Estimated H-index: 85
(NYU: New York University)
+ 4 AuthorsEzekiel J. Emanuel107
Estimated H-index: 107
(Leonard Davis Institute of Health Economics)
Importance Medicare launched the mandatory Comprehensive Care for Joint Replacement bundled payment model in 67 urban areas for approximately 800 hospitals following its experience in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) demonstration projects. Little information from ACE and BPCI exists to guide hospitals in redesigning care for mandatory joint replacement bundles. Objective To analyze changes in quality, internal hospital costs, and postacute care (PAC) spending for lower extremity joint replacement bundled payment episodes encompassing hospitalization and 30 days of PAC. Design, Setting, and Participants This observational study followed 3942 total patients with lower extremity joint replacement at Baptist Health System (BHS), which participated in ACE and BPCI. Exposures Lower extremity joint replacement surgery under bundled payment at BHS. Main Outcomes and Measures Average Medicare payments per episode, readmissions, emergency department visits, prolonged length of stay, and hospital savings from changes in internal hospital costs and PAC spending. Results Overall, 3942 patients (mean [SD] age, 72.4 [8.4] years) from BHS were observed. Between July 2008 and June 2015, average Medicare episode expenditures declined 20.8%, from 26 785 to 1 208 ( P P  = .61) for 204 episodes of joint replacement with complications. Readmissions and emergency department visits declined 1.4% ( P  = .14) and 0.9% ( P  = .98), respectively, while episodes with prolonged length of stay decreased 67.0% ( P Conclusions and Relevance During a period in which Medicare payments for joint replacement episodes increased by 5%, bundled payment for procedures at BHS was associated with substantial hospital savings and reduced Medicare payments. Decreases in PAC spending occurred only when it was included in the bundle.
Figures & Tables
📖 Papers frequently viewed together
14 Authors (Jaclyn Marshall)
Importance Bundled Payments for Care Improvement (BPCI) is a voluntary initiative of the Centers for Medicare & Medicaid Services to test the effect of holding an entity accountable for all services provided during an episode of care on episode payments and quality of care. Objective To evaluate whether BPCI was associated with a greater reduction in Medicare payments without loss of quality of care for lower extremity joint (primarily hip and knee) replacement episodes initiated in BPCI-partici...
#1Elliott S. Fisher (The Dartmouth Institute for Health Policy and Clinical Practice)H-Index: 92
#1Art SedrakyanH-Index: 40
#2Hooman KamelH-Index: 58
Last. Subroto PaulH-Index: 27
view all 5 authors...
Readmission and length of stay (LOS) are increasingly accepted as quality measures for surgical care. Centers for Medicare & Medicaid Services will soon assess penalties for excessive readmissions after coronary artery bypass graft (CABG) surgery and hip and knee replacements.To determine and compare population level changes in LOS and relationship with 30-day readmission over time for patients undergoing CABG and hip and knee replacements. Secondary objective was to determine relationship betwe...
#1Prem N. Ramkumar (HSS: Hospital for Special Surgery)H-Index: 19
#2Christopher T Chu (HSS: Hospital for Special Surgery)H-Index: 1
Last. Linda T. Li (HSS: Hospital for Special Surgery)H-Index: 21
view all 9 authors...
Abstract To address the lack of consensus on the leading reasons for readmissions after primary elective unilateral total joint arthroplasties (TJAs), we performed a systematic review and a meta-analysis to identify overall and cause-specific readmission rates. We performed structured searches of the Medline and Cochrane databases for original reports-published between January 1982 and January 2013-on both 30- and 90-day follow-ups of unique patient populations that underwent elective primary TJ...
New targets have been set for value-based payment: 85% of Medicare fee-for-service payments should be tied to quality or value by 2016, and 30% of Medicare payments should be tied to quality or value through alternative payment models by 2016 (50% by 2018).
#1Thomas C. Tsai (Office of the Assistant Secretary for Planning and Evaluation)H-Index: 22
#2Karen E. Joynt (Harvard University)H-Index: 34
Last. Ashish K. Jha (Harvard University)H-Index: 95
view all 5 authors...
The Bundled Payments for Care Improvement initiative is a federally funded innovation model mandated by the Affordable Care Act. It is designed to help transition Medicare away from fee-for-service payments and toward bundling a single payment for an episode of acute care in a hospital and related postacute care in an appropriate setting. While results from the initiative will not be available for several years, current data can help provide critical early insights. However, little is known abou...
#1Carl van WalravenH-Index: 69
#2Peter C. AustinH-Index: 127
Last. Alan J. ForsterH-Index: 35
view all 5 authors...
Background: Comorbidity measures are necessary to describe patient populations and adjust for confounding. In direct comparisons, studies have found the Elixhauser comorbidity system to be statistically slightly superior to the Charlson comorbidity system at adjusting for comorbidity. However, the Elixhauser classification system requires 30 binary variables, making its use for reporting and analysis of comorbidity cumbersome. Objective: Modify the Elixhauser classification system into a single ...
#1Robert S. KaplanH-Index: 82
#2Steven R. AndersonH-Index: 4
In the classroom, ABC looks like a great way to manage a company's resources. But many executives who have tried to implement ABC on a large scale in their organizations have found the approach limiting and frustrating. Why? The employee surveys that companies used to estimate resources required for business activities proved too time-consuming, expensive, and irritating to employees. This book shows you how to implement time-driven activity-based costing (TDABC), an easier and more powerful way...
#1Danielle A. Southern (U of C: University of Calgary)H-Index: 23
#2Hude QuanH-Index: 79
Last. William A. GhaliH-Index: 101
view all 3 authors...
Background: Comorbidity risk adjustment methods have been used widely with administrative data, and the Charlson/Deyo method is perhaps the most commonly used in the literature. However, a new method defined by Elixhauser et al. has been introduced recently and could be superior, although it has not been validated widely. Objectives: We compared the Charlson/Deyo and Elixhauser methods using Canadian administrative data on patients with myocardial infarction (MI). Research Design: We conducted a...
Cited By182
#2Michael P. SchnetzH-Index: 6
Last. A. Murat Kaynar (University of Pittsburgh)H-Index: 16
view all 7 authors...
BACKGROUND Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system. METHODS Th...
#1Niraja Rajan (PSU: Pennsylvania State University)H-Index: 3
#2Eric B. Rosero (UTSW: University of Texas Southwestern Medical Center)H-Index: 23
Last. Girish P. Joshi (UTSW: University of Texas Southwestern Medical Center)H-Index: 51
view all 3 authors...
With migration of medically complex patients undergoing more extensive surgical procedures to the ambulatory setting, selecting the appropriate patient is vital. Patient selection can impact patient safety, efficiency, and reportable outcomes at ambulatory surgery centers (ASCs). Identifying suitability for ambulatory surgery is a dynamic process that depends on a complex interplay between the surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analge...
#1Victor Davila (OSU: Ohio State University)H-Index: 4
#2Girish P. Joshi (UTSW: University of Texas Southwestern Medical Center)H-Index: 51
#1Joseph Serino (Rush University)H-Index: 4
#2Robert A. Burnett (Rush University)H-Index: 4
Last. P. Maxwell Courtney (Thomas Jefferson University)H-Index: 13
view all 4 authors...
BACKGROUND Post-acute care remains a target for episode-of-care cost reduction following total hip arthroplasty (THA). The introduction of bundled payment models in the United States in 2013 aligned incentives among providers to reduce post-acute care resource utilization. Institution-level studies have shown increased rates of home discharge with substantial cost savings after adoption of bundled payment models; however, national data have yet to be reported. The purpose of this study was to ev...
#1Sean R. McClellan (Centers for Medicare and Medicaid Services)H-Index: 9
#4Daver C. Kahvecioglu (HHS: United States Department of Health and Human Services)H-Index: 7
BACKGROUND The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative tested whether episode-based payment models could reduce Medicare payments without harming quality. Among patients with vulnerabilities, BPCI appeared to effectively reduce payments while maintaining the quality of care. However, these findings could overlook potential adverse patient-reported outcomes in this population. RESEARCH DESIGN We surveyed beneficiaries with 4 characteristics...
#1Elizabeth Duckworth (University of Texas at Austin)
#2C. M. P. Mather (Duke University)H-Index: 2
Last. Prakash Jayakumar (University of Texas at Austin)H-Index: 15
view all 5 authors...
Abstract null null Osteoarthritis (OA) of the knee is a common and disabling condition that represents around 20% of the global burden of musculoskeletal disease with a lifetime risk estimated at 13-26%. The escalation in cases is associated with a rise in ageing and obese populations. OA of the knee is also now recognized as a multi-faceted problem affecting not only an individual's physical health but their psychological and social wellbeing. Thus, a condition-focused, whole person approach th...
#1Thomas B. Cwalina (Cleveland Clinic)H-Index: 1
#2Tarun K. Jella (Cleveland Clinic)H-Index: 5
Last. Atul F. Kamath (Cleveland Clinic)H-Index: 28
view all 5 authors...
BACKGROUND The Merit-based Incentive Payment System (MIPS) is the latest value-based payment program implemented by the Centers for Medicare and Medicaid Services. As performance-based bonuses and penalties continue to rise in magnitude, it is essential to evaluate this program's ability to achieve its core objectives of quality improvement, cost reduction, and competition around clinically meaningful outcomes. QUESTIONS/PURPOSES We asked the following: (1) How do orthopaedic surgeons differ on ...
#1Brian Downer (UTMB: University of Texas Medical Branch)H-Index: 15
#2Timothy A. Reistetter (University of Texas Health Science Center at San Antonio)H-Index: 18
Last. Kenneth J. Ottenbacher (UTMB: University of Texas Medical Branch)H-Index: 85
view all 8 authors...
ABSTRACT Objective To determine if patients with a total or partial hip replacement admitted to a skilled nursing facility (SNF) after the improvement in function quality measure was added to Nursing Home Compare in July 2016 have greater physical recovery than patients admitted before July 2016. Design Pre (1/1/2015–6/30/2016) versus post (7/1/2016–12/31/2017) design. Setting Skilled Nursing Facilities (n=12,829). Participants Medicare fee-for-service beneficiaries discharged from acute hospita...
#1Neil Jordan (NU: Northwestern University)H-Index: 17
#2Anne Deutsch (RTI International)H-Index: 25
Abstract null null The health care delivery landscape in the United States is changing as payment models consider both costs and health outcomes, which are key components of value in health care. Without evidence about the effectiveness and costs of rehabilitation interventions, it is difficult to judge the value of rehabilitation interventions. Understanding the short- and long-term costs associated with implementing a rehabilitation intervention and the intervention's cost-effectiveness compar...
#1Karen E. Joynt Maddox (WashU: Washington University in St. Louis)H-Index: 23
#2Michael L. Barnett (Brigham and Women's Hospital)H-Index: 42
Last. Arnold M. Epstein (Brigham and Women's Hospital)H-Index: 104
view all 6 authors...
Background null Model 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown. null Methods null Retrospective cohort study using Medicare claims from 2012 to 2017. We used an interrupted time-series design to compare participating vs matched control SNFs on total 90-day Medicare pay...
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.