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

Published on Jan 6, 2020in Health Affairs5.331
· DOI :10.1377/HLTHAFF.2019.00466
Amol S. Navathe16
Estimated H-index: 16
(Leonard Davis Institute of Health Economics),
Ezekiel J. Emanuel107
Estimated H-index: 107
(UPenn: University of Pennsylvania)
+ 11 AuthorsJoshua M. Liao13
Estimated H-index: 13
(Leonard Davis Institute of Health Economics)
Sources
Abstract
Medicare has reinforced its commitment to voluntary bundled payment by building upon the Bundled Payments for Care Improvement (BPCI) initiative via an ongoing successor program, the BPCI Advanced ...
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In 2016 Medicare implemented its first mandatory alternative payment model, the Comprehensive Care for Joint Replacement (CJR) program, in which the agency pays clinicians and hospitals a fixed amo...
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Abstract Background In 2016, Medicare implemented Comprehensive Care for Joint Replacement (CJR), a national mandatory bundled-payment model for hip or knee replacement in randomly selected metropo...
108 CitationsSource
#1J. Michael McWilliams (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 33
#2Laura A. Hatfield (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 22
Last. Michael E. Chernew (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 67
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Abstract Background Health care providers who participate as an accountable care organization (ACO) in the voluntary Medicare Shared Savings Program (MSSP) have incentives to lower spending for Medicare patients while achieving high performance on a set of quality measures. Little is known about the extent to which early savings achieved by ACOs in the program have grown and been replicated by ACOs that entered the program in later years. ACOs that are physician groups have stronger incentives t...
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#1Amy Finkelstein (MIT: Massachusetts Institute of Technology)H-Index: 66
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Importance Bundled payments are an increasingly common alternative payment model for Medicare, yet there is limited evidence regarding their effectiveness. Objective To report interim outcomes from the first year of implementation of a bundled payment model for lower extremity joint replacement (LEJR). Design, Setting, and Participants As part of a 5-year, mandatory-participation randomized trial by the Centers for Medicare & Medicaid Services, eligible metropolitan statistical areas (MSAs) were...
80 CitationsSource
#1Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 16
#2Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 13
Last. Ezekiel J. Emanuel (Leonard Davis Institute of Health Economics)H-Index: 107
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Importance Medicare’s Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with a reduction in episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes paid for by Medicare, which could potentially eliminate program-related savings or prompt them to shift case mix to lower-risk patients. Objective To evalua...
34 CitationsSource
#1Amol S. Navathe (UPenn: University of Pennsylvania)H-Index: 16
#2Joshua M. Liao (UW: University of Washington)H-Index: 13
Last. Ezekiel J. Emanuel (UPenn: University of Pennsylvania)H-Index: 107
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We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk...
16 CitationsSource
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#1Karen E. Joynt Maddox (WashU: Washington University in St. Louis)H-Index: 20
#2E. John Orav (Brigham and Women's Hospital)H-Index: 110
Last. Arnold M. Epstein (Harvard University)H-Index: 105
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#2Amanda Holdofski (Baptist Health System)H-Index: 1
Last. Amol S. Navathe (UPenn: University of Pennsylvania)H-Index: 16
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Abstract • Program design features (e.g., governance method, payout design) can be used effectively to gain physician buy-in and participation within organizations undertaking new bundled payment programs. • Gainsharing mechanisms that intentionally integrate individual- and cohort-level incentives maximize behavior change for physicians across the performance spectrum. • Data transparency is vital to bundling efforts: it fosters the kind of communication, feedback, and consensus needed not only...
10 CitationsSource
#1Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 16
#2Andrea B. Troxel (NYU: New York University)H-Index: 85
Last. Ezekiel J. Emanuel (Leonard Davis Institute of Health Economics)H-Index: 107
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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...
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#1Karen E. Joynt Maddox (WashU: Washington University in St. Louis)H-Index: 20
#2Michael L. Barnett (Brigham and Women's Hospital)H-Index: 36
Last. Arnold M. Epstein (Brigham and Women's Hospital)H-Index: 105
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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...
1 CitationsSource
#1Amol S. Navathe (Leonard Davis Institute of Health Economics)H-Index: 16
#2Joshua M. Liao (Leonard Davis Institute of Health Economics)H-Index: 13
Last. Rachel M. Werner (Leonard Davis Institute of Health Economics)H-Index: 41
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Importance null It is unknown how outcomes are affected when patients receive care under bundled payment and accountable care organization (ACO) programs simultaneously. null Objective null To evaluate whether outcomes in the Medicare Bundled Payments for Care Improvement (BPCI) program differed depending on whether patients were attributed to ACOs in the Medicare Shared Savings Program. null Design, Setting, and Participants null This cohort study was conducted using Medicare claims data from J...
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#1Joshua M. Liao (UW: University of Washington)H-Index: 13
#2Atul Gupta (UPenn: University of Pennsylvania)H-Index: 6
Last. Amol S. Navathe (UPenn: University of Pennsylvania)H-Index: 16
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#1Nicholas L. Berlin (UM: University of Michigan)H-Index: 9
Last. Andrew M. Ryan (UM: University of Michigan)H-Index: 41
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The Bundled Payments for Care Improvement initiative Advanced Model (BPCI Advanced) is a voluntary Medicare bundled payment model in which hospitals may participate with third-party conveners-private consulting firms that share in the financial risk built into the program. We found that nonteaching and for-profit status was associated with a higher probability of hospital partnership with third-party conveners in BPCI Advanced. Among hospitals participating in at least one inpatient clinical epi...
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#1Emeline M. Aviki (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 7
Last. Haley A. Moss (Duke University)H-Index: 9
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#1Benjamin A. Y. Cher (UM: University of Michigan)H-Index: 1
#2Baris Gulseren (UM: University of Michigan)H-Index: 2
Last. Andrew M. Ryan (UM: University of Michigan)H-Index: 41
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OBJECTIVE To compare the predictive accuracy of two approaches to target price calculations under Bundled Payments for Care Improvement-Advanced (BPCI-A): the traditional Centers for Medicare and Medicaid Services (CMS) methodology and an empirical Bayes approach designed to mitigate the effects of regression to the mean. DATA SOURCES Medicare fee-for-service claims for beneficiaries discharged from acute care hospitals between 2010 and 2016. STUDY DESIGN We used data from a baseline period (dis...
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#2Austin J BorjaH-Index: 6
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BACKGROUND The goal of bundled payments-lump monetary sums designed to cover the full set of services needed to provide care for a condition or medical event-is to provide a reimbursement structure that incentivizes improved value for patients. There is concern that such a payment mechanism may lead to patient screening and denying or providing orthopaedic care to patients based on the number and severity of comorbid conditions present associated with complications after surgery. Currently, howe...
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Countries seeking to move away from a purely fee-for-service (FFS) system may consider a hybrid approach whereby only some procedures are paid by FFS while others are paid prospectively. Yet little evidence exists whether such a hybrid payment system contains overall costs without adverse influences on health outcomes. In 2003, Japan experienced a reform from FFS to a hybrid payment system in which only some inpatient procedures were paid prospectively. We exploit this reform to test how such a ...
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