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)
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Abstract
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.
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