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Sankaran R, Gulseren B, Prescott HC, Langa KM, Nguyen T, Ryan AM. Identifying Sources of Inter-hospital Variation in Episode Spending for Sepsis Care. Med Care 2024:00005650-990000000-00225. [PMID: 38625015 DOI: 10.1097/mlr.0000000000002000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To evaluate inter-hospital variation in 90-day total episode spending for sepsis, estimate the relative contributions of each component of spending, and identify drivers of spending across the distribution of episode spending on sepsis care. DATA SOURCES/STUDY SETTING Medicare fee-for-service claims for beneficiaries (n=324,694) discharged from acute care hospitals for sepsis, defined by MS-DRG, between October 2014 and September 2018. RESEARCH DESIGN Multiple linear regression with hospital-level fixed effects was used to identify average hospital differences in 90-day episode spending. Separate multiple linear regression and quantile regression models were used to evaluate drivers of spending across the episode spending distribution. RESULTS The mean total episode spending among hospitals in the most expensive quartile was $30,500 compared with $23,150 for the least expensive hospitals (P<0.001). Postacute care spending among the most expensive hospitals was almost double that of least expensive hospitals ($7,045 vs. $3,742), accounting for 51% of the total difference in episode spending between the most expensive and least expensive hospitals. Female patients, patients with more comorbidities, urban hospitals, and BPCI-A-participating hospitals were associated with significantly increased episode spending, with the effect increasing at the right tail of the spending distribution. CONCLUSION Inter-hospital variation in 90-day episode spending on sepsis care is driven primarily by differences in post-acute care spending.
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Affiliation(s)
- Roshun Sankaran
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Baris Gulseren
- Department of Health Management and Policy, University of Michigan School of Public Health
- Center for Evaluation Health Reform, University of Michigan
| | | | - Kenneth M Langa
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
| | - Thuy Nguyen
- Department of Health Management and Policy, University of Michigan School of Public Health
- Center for Evaluation Health Reform, University of Michigan
| | - Andrew M Ryan
- Department of Health Services, Policy, and Practice, Center for Health Policy, Brown University, Providence, RI
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Milstein R, Schreyögg J. The end of an era? Activity-based funding based on diagnosis-related groups: A review of payment reforms in the inpatient sector in 10 high-income countries. Health Policy 2024; 141:104990. [PMID: 38244342 DOI: 10.1016/j.healthpol.2023.104990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/22/2024]
Abstract
CONTEXT Across the member countries of the Organisation for Economic Co-Operation and Development, policy makers are searching for new ways to pay hospitals for inpatient care to move from volume to value. This paper offers an overview of the latest reforms and their evidence to date. METHODS We reviewed reforms to DRG payment systems in 10 high-income countries: Australia, Austria, Canada (Ontario), Denmark, France, Germany, Norway, Poland, the United Kingdom (England), and the United States. FINDINGS We identified four reform trends among the observed countries, them being (1) reductions in the overall share of inpatient payments based on DRGs, (2) add-on payments for rural hospitals or their exclusion from the DRG system, (3) episode-based payments, which use one joint price to pay providers for all services delivered along a patient pathway, and (4) financial incentives to shift the delivery of care to less costly settings. Some countries have combined some or all of these measures with financial adjustments for quality of care. These reforms demonstrate a shift away from activity and efficiency towards a diversified set of targets, and mirror efforts to slow the rise in health expenditures while improving quality of care. Where evaluations are available, the evidence indicates mixed success in improving quality of care and reducing costs and expenditures.
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Affiliation(s)
- Ricarda Milstein
- Universität Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany.
| | - Jonas Schreyögg
- Universität Hamburg, Hamburg Center for Health Economics, Esplanade 36, 20354 Hamburg, Germany
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3
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Lavu MS, Hecht CJ, McNassor R, Burkhart RJ, Kamath AF. Implant Selection Strategies for Total Joint Arthroplasty: The Effects on Cost Containment and Physician Autonomy. J Arthroplasty 2023; 38:2724-2730. [PMID: 37276950 DOI: 10.1016/j.arth.2023.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND With continued declines in reimbursement for total joint arthroplasty, health systems have explored implant cost containment measures to generate sustainable margins. This review evaluated how implementation of (1) implant price control programs, (2) vendor purchasing agreements, and (3) bundled payment models affected implant costs and physician autonomy in implant selection. METHODS PubMed, EBSCOhost, and Google Scholar were searched to identify studies that evaluated the efficacy of total hip or total knee arthroplasty implant selection strategies. The review included publications between January 1, 2002, and October 17, 2022. The mean Methodological Index for Nonrandomized Studies score was 18.3 ± 1.8. RESULTS A total of 13 studies (32,197 patients) were included. All studies implementing implant price capitation programs found decreased implant costs, ranging 2.2 to 26.1% and increased utilization of premium implants. Most studies found bundled payments models reduced total joint arthroplasty implant costs with greatest reduction being 28.9%. Additionally, while absolute single vendor agreements had higher implant costs, preferred single vendor agreements had reduced implant costs. When given price constraints, surgeons tended to select more premium implants. CONCLUSION Alternative payment models that incorporated implant selection strategies saw reduced costs and surgeon utilization of premium implants. The study findings encourage further research on implant selection strategies, which must balance the goals of cost containment with physician autonomy and optimized patient care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Monish S Lavu
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ryan McNassor
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert J Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Pott C, Stargardt T, Frey S. Does prospective payment influence quality of care? A systematic review of the literature. Soc Sci Med 2023; 323:115812. [PMID: 36913795 DOI: 10.1016/j.socscimed.2023.115812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
In the light of rising health expenditures, the cost-efficient provision of high-quality inpatient care is on the agenda of policy-makers worldwide. In the last decades, prospective payment systems (PPS) for inpatient care were used as an instrument to contain costs and increase transparency of provided services. It is well documented in the literature that prospective payment has an impact on structure and processes of inpatient care. However, less is known about its effect on key outcome indicators of quality of care. In this systematic review, we synthesize evidence from studies investigating how financial incentives induced by PPS affect indicators of outcome quality domains of care, i.e. health status and user evaluation outcomes. We conduct a review of evidence published in English, German, French, Portuguese and Spanish language produced since 1983 and synthesize results of the studies narratively by comparing direction of effects and statistical significance of different PPS interventions. We included 64 studies, where 10 are of high, 18 of moderate and 36 of low quality. The most commonly observed PPS intervention is the introduction of per-case payment with prospectively set reimbursement rates. Abstracting evidence on mortality, readmission, complications, discharge disposition and discharge destination, we find the evidence to be inconclusive. Thus, claims that PPS either cause great harm or significantly improve the quality of care are not supported by our findings. Further, the results suggest that reductions of length of stay and shifting treatment to post-acute care facilities may occur in the course of PPS implementations. Accordingly, decision-makers should avoid low capacity in this area.
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De Roo AC, Ha J, Regenbogen SE, Hoffman GJ. Impact of Medicare eligibility on informal caregiving for surgery and stroke. Health Serv Res 2023; 58:128-139. [PMID: 35791447 PMCID: PMC9836945 DOI: 10.1111/1475-6773.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. DATA SOURCES Health and Retirement Study survey data (1998-2018). STUDY DESIGN We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. DATA COLLECTION Not applicable. PRINCIPAL FINDINGS A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt. CONCLUSIONS Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
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Affiliation(s)
- Ana C. De Roo
- Department of SurgeryUniversity of MichiganAnn ArborMichiganUSA,Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMichiganUSA,Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Jinkyung Ha
- Division of Geriatric and Palliative Medicine, Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Scott E. Regenbogen
- Department of SurgeryUniversity of MichiganAnn ArborMichiganUSA,Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMichiganUSA,Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA
| | - Geoffrey J. Hoffman
- Institute for Healthcare Policy and Innovation, University of MichiganAnn ArborMichiganUSA,Department of Systems, Populations and LeadershipUniversity of Michigan School of NursingAnn ArborMichiganUSA
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Sniderman J, Krueger C, Wolfstadt J. Bundled Care in Elective Total Joint Replacement: Payment Models in Sweden, Canada, and the United States: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202211000-00001. [PMID: 36574410 DOI: 10.2106/jbjs.rvw.22.00082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➢ Rising health-care expenditures and payer dissatisfaction with traditional models of reimbursement have driven an interest in alternative payment model initiatives. ➢ Bundled payments, an alternative payment model, have been introduced for total joint replacement in Sweden, the United States, and Canada to help to curb costs, with varying degrees of success. ➢ Outpatient total knee arthroplasty and total hip arthroplasty are becoming increasingly common and provide value for patients and payers, but have negatively impacted providers participating in bundled payment models due to considerable losses and decreased reimbursement. ➢ A fine balance exists between achieving cost savings for payers and enticing participation by providers in bundled payment models. ➢ The design of each model is key to payer, provider, and patient satisfaction and should feature comprehensive coverage for a full cycle of care whether it is in the inpatient or outpatient setting, is linked to quality and patient-reported outcomes, features appropriate risk adjustment, and sets limits on responsibility for unrelated complications and extreme outlier events.
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Affiliation(s)
- Jhase Sniderman
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Jesse Wolfstadt
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Granovsky Gluskin Division of Orthopaedic Surgery, Sinai Health, Toronto, Ontario, Canada
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7
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Meng Z, Zou K, Song S, Wu H, Han Y. Associations of Chinese diagnosis-related group systems with inpatient expenditures for older people with hip fracture. BMC Geriatr 2022; 22:169. [PMID: 35232376 PMCID: PMC8887083 DOI: 10.1186/s12877-022-02865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hip fracture is frequent in older people and represents a major public health issue worldwide. The increasing incidence of hip fracture and the associated hospitalization costs place a significant economic burden on older patients and their families. On January 1, 2018, the Chinese diagnosis-related group (C-DRG) payment system, which aims to reduce financial barriers, was implemented in Sanming City, southern China. This study aimed to evaluate the associations of C-DRG system with inpatient expenditures for older people with hip fracture. Methods An uncontrolled before-and-after study employed data of all the patients with hip fracture aged 60 years or older from all the public hospitals enrolled in the Sanming Basic Health Insurance Scheme from January 1, 2016 to December 31, 2018. The ‘pre C-DRG sample’ included patients from January 1, 2016 to December 31, 2017. The ‘post C-DRG sample’ included patients from January 1, 2018 to December 31, 2018. A propensity score matching analysis was used to adjust the difference in baseline characteristic parameters between the pre and post samples. Data were analyzed using generalized linear models adjusted for the demographic, clinical, and institutional factors. Robust tests were performed by accounting for time trend, the fixed effects of the year and hospitals, and clustering effect within hospitals. Results After propensity score matching, we obtained two homogeneous groups of 1123 patients each, and the characteristic variables of the two matched groups were similar. We found that C-DRG reform was associated with a 19.51% decrease in out-of-pocket (OOP) payments (p < 0.001) and a 99.93% decrease in OOP payments as a share of total inpatient expenditure (p < 0.001); whereas total inpatient expenditure was not significantly associated with the C-DRG reform. All the sensitivity analyses did not change the results significantly. Conclusion The implementation of C-DRG payment system reduced both the absolute amount of OOP payments and OOP payments as a share of total inpatient expenditure for older patients with hip fracture, without affecting total inpatient expenditure. These results may provide significant insights for policymakers in reducing the financial burden on older patients with hip fracture in other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02865-3.
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Affiliation(s)
- Zhaolin Meng
- School of Nursing, Capital Medical University, Beijing, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Suhang Song
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Huazhang Wu
- Department of Health Service Management, China Medical University, Shenyang, Liaoning, China
| | - Youli Han
- Department of Health Management and Policy, School of Public Health, Capital Medical University, NO 10, Xi Toutiao Rd Youanmenwai District, Beijing, 100069, China.
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8
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Dimick JB. From Surgeon-Scientist, to Mentor, to Department Chair: 10 Years after Receiving the Jacobson Promising Investigator Award. J Am Coll Surg 2021; 233:468-470. [PMID: 34166837 DOI: 10.1016/j.jamcollsurg.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI.
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9
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Abstract
Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.
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Affiliation(s)
- Joshua M Liao
- Department of Medicine, School of Medicine, University of Washington, Seattle, Washington 98195, USA; .,Value and Systems Science Lab, School of Medicine, University of Washington, Seattle, Washington 98195, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Amol S Navathe
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania 19104, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Rachel M Werner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania 19104, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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10
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Berlin NL, Chung KC, Matros E, Chen JS, Momoh AO. The Costs of Breast Reconstruction and Implications for Episode-Based Bundled Payment Models. Plast Reconstr Surg 2020; 146:721e-30e. [PMID: 33234949 DOI: 10.1097/PRS.0000000000007329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implementation of payment reform for breast reconstruction following mastectomy demands a comprehensive understanding of costs related to the complex process of reconstruction. Bundled payments for services to women with breast cancer may profoundly impact reimbursement and access to breast reconstruction. The authors' objectives were to determine the contribution of cancer therapies, comorbidities, revisions, and complications to costs following immediate reconstruction and the optimal duration of episodes to incentivize cost containment for bundled payment models. METHODS The cohort was composed of women who underwent immediate breast reconstruction between 2009 and 2016 from the MarketScan Commercial Claims and Encounters database. Continuous enrollment for 3 months before and 24 months after reconstruction was required. Total costs were calculated within predefined episodes (30 days, 90 days, 1 year, and 2 years). Multivariable models assessed predictors of costs. RESULTS Among 15,377 women in the analytic cohort, 11,592 (75 percent) underwent tissue expander, 1279 (8 percent) underwent direct-to-implant, and 2506 (16 percent) underwent autologous reconstruction. Adjuvant therapies increased costs at 1 year [tissue expander, $39,978 (p < 0.001); direct-to-implant, $34,365 (p < 0.001); and autologous, $29,226 (p < 0.001)]. At 1 year, most patients had undergone tissue expander exchange (76 percent) and revisions (81 percent), and a majority of complications had occurred (87 percent). Comorbidities, revisions, and complications increased costs for all episode scenarios. CONCLUSIONS Episode-based bundling should consider separate bundles for medical and surgical care with adjustment for procedure type, cancer therapies, and comorbidities to limit the adverse impact on access to reconstruction. The authors' findings suggest that a 1-year time horizon may optimally capture reconstruction events and complications.
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11
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Abstract
Policy Points Evidence suggests that bundled payment contracting can slow the growth of payer costs relative to fee-for-service contracting, although bundled payment models may not reduce absolute costs. Bundled payments may be more effective than fee-for-service payments in containing costs for certain medical conditions. For the most part, Medicare's bundled payment initiatives have not been associated with a worsening of quality in terms of readmissions, emergency department use, and mortality. Some evidence suggests a worsening of other quality measures for certain medical conditions. Bundled payment contracting involves trade-offs: Expanding a bundle's scope and duration may better contain costs, but a more comprehensive bundle may be less attractive to providers, reducing their willingness to accept it as an alternative to fee-for-service payment. CONTEXT Bundled payments have been promoted as an alternative to fee-for-service payments that can mitigate the incentives for service volume under the fee-for-service model. As Medicare has gained experience with bundled payments, it has widened their scope and increased their duration. However, there have been few reviews of the empirical literature on the impact of Medicare's bundled payment programs on cost, resource use, utilization, and quality. METHODS We examined the history and features of 16 of Medicare's bundled payment programs involving hospital-initiated episodes of care and conducted a literature review of articles about those programs. Database and additional searches yielded 1,479 articles. We evaluate the studies' methodological quality and summarize the quantitative findings about Medicare expenditures and quality of care from 37 studies that used higher-quality research designs. FINDINGS Medicare's bundled payment initiatives have varied in their design features, such as episode scope and duration. Many initiatives were associated with little to no reduction in Medicare expenditures, unless large pricing discounts for providers were negotiated in advance. Initiatives that included post-acute care services were associated with lower expenditures for certain conditions. Hospitals may have been able to reduce internal production costs with help from physicians via gainsharing. Most initiatives were not associated with significant changes in quality of care, as measured by readmission and mortality rates. Of the significant changes in readmission rates, the results were mixed, showing increases and decreases associated with bundled payments. Some evidence suggested that worse patient outcomes were associated bundled payments, although most results were not statistically significant. Results on case-mix selection were mixed: Several initiatives were associated with reductions in episode severity, whereas others were associated with little change. CONCLUSIONS Bundled payments for hospital-initiated episodes may be a good alternative to fee-for-service payments. Bundled payments can help slow the growth of payer spending, although they do not necessarily reduce absolute spending. They are associated with lower provider production costs, and there is no overwhelming evidence of compromised quality. However, designing a bundled payment contract that is attractive to both providers and payers proves to be a challenge.
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Affiliation(s)
- CHRISTINE A. YEE
- Partnered Evidence-based Policy Resource CenterVA Boston Healthcare System
- University of Maryland Baltimore County
- School of Public HealthBoston University
| | - STEVEN D. PIZER
- Partnered Evidence-based Policy Resource CenterVA Boston Healthcare System
- School of Public HealthBoston University
| | - AUSTIN FRAKT
- Partnered Evidence-based Policy Resource CenterVA Boston Healthcare System
- School of Public HealthBoston University
- T.H. Chan School of Public HealthHarvard University
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Agarwal R, Liao JM, Gupta A, Navathe AS. The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review. Health Aff (Millwood) 2020; 39:50-57. [DOI: 10.1377/hlthaff.2019.00784] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Rajender Agarwal
- Rajender Agarwal is director of the Center for Health Reform, in Southlake, Texas
| | - Joshua M. Liao
- Joshua M. Liao is medical director of payment strategy, director of the Value and Systems Science Lab, and an assistant professor in the Department of Medicine, all at the University of Washington, in Seattle, and an adjunct senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia
| | - Ashutosh Gupta
- Ashutosh Gupta is associate director of the Center for Health Reform and a gastroenterologist at ProCare Gastroenterology, in Odessa, Texas
| | - Amol S. Navathe
- Amol S. Navathe is a core investigator at the Corporal Michael J. Cresencz Veterans Affairs Medical Center, in Philadelphia, and an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and a senior fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania
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13
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Mehta R, Paredes AZ, Tsilimigras DI, Farooq A, Sahara K, Merath K, Hyer JM, White S, Ejaz A, Tsung A, Dillhoff M, Cloyd JM, Pawlik TM. CMS Hospital Compare System of Star Ratings and Surgical Outcomes Among Patients Undergoing Surgery for Cancer: Do the Ratings Matter? Ann Surg Oncol 2019; 27:3138-3146. [PMID: 31792714 DOI: 10.1245/s10434-019-08088-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services (CMS) Hospital Compare star rating system has been proposed as a means to assess hospital quality performance. The current study aimed to investigate outcomes and payments among patients undergoing surgery for colorectal, lung, esophageal, pancreatic, and liver cancer across hospital star rating groups. METHODS The Medicare Standard Analytic Files (SAF) from 2013 to 2015 were used to derive the analytic cohort. The association of star ratings to perioperative outcomes and expenditures was examined. RESULTS Among 119,854 patients, the majority underwent surgery at a 3-star (n = 34,901, 29.1%) or 4-star (n = 30,492, 25.4%) hospital. Only 12.2% (n = 14,732) were treated at a 5-star hospital. Across all procedures examined, patients who underwent surgery at a 1-star hospital had greater odds of death within 90 days than patients who had surgery at a 5-star hospital (colorectal, 1.41 [95% confidence interval {CI}, 1.25-1.60]; lung, 1.97 [95% CI 1.56-2.48]; esophagectomy, 1.83 [95% CI 0.81-4.16]; pancreatectomy, 1.70 [95% CI 1.20-2.41]; hepatectomy, 1.63 [95% CI 0.96-2.77]). A similar trend was noted for failure to rescue (FTR), with the greatest odds of FTR associated with 1-star hospitals. The median expenditure associated with an abdominal operation was $1661 more at a 1-star hospital than at a 5-star hospital (1-star: $17,399 vs 5-star: $15,738). A similar trend was noted for thoracic operations. CONCLUSION The risk of FTR, 90-day mortality, and increased hospital expenditure were all higher at a 1-star hospital. Further research is needed to investigate barriers to care at 5-star-rated hospitals and to target specific interventions to improve outcomes at 1-star hospitals.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Ayesha Farooq
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Kota Sahara
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Katiuscha Merath
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Susan White
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH, USA.
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Haas DA, Zhang X, Kaplan RS, Song Z. Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements. JAMA Intern Med 2019; 179:924-931. [PMID: 31157819 PMCID: PMC6547121 DOI: 10.1001/jamainternmed.2019.0480] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. OBJECTIVE To evaluate changes in key economic and clinical outcomes associated with the CJR model. DESIGN, SETTING, AND PARTICIPANTS A retrospective, national, population-based analysis of Medicare fee-for-service beneficiaries undergoing lower extremity joint replacement was conducted using 100% Medicare Part A data and 5% Medicare Part B data. Within an intention-to-treat framework, a difference-in-differences approach was used to compare Medicare spending, quality of care, volume of episodes, and patient selection in episodes of lower extremity joint replacements in the first 2 years of the program between propensity score-matched CJR and non-CJR hospitals (episodes initiated from April 1, 2016, through December 31, 2017, with the latter completed by March 31, 2018). Lower extremity joint replacement episodes in MSAs randomly assigned to the CJR model were compared with those in MSAs not assigned to the CJR model. EXPOSURES Random assignment of MSAs into the CJR model within prespecified strata. MAIN OUTCOMES AND MEASURES Spending and its components, quality of care, volume of episodes, and patient characteristics were the main outcomes. RESULTS After propensity score matching, there were 157 828 primary lower extremity joint replacement cases across 684 hospitals in the CJR (treatment) group (101 641 [64.4%] women; mean [SD] age, 72.8 [8.9] years) and 180 594 cases across 726 hospitals in the non-CJR (control) group (115 580 women [64.0%] women; mean [SD] age, 72.6 [8.8] years). The CJR was associated with a decrease of $582 per episode in Medicare Part A spending, a 2.5% savings on claims (95% CI, -$873 to -$290; P < .001) driven by a 5.5% decline in 90-day postacute care spending, concentrated in skilled nursing facilities (-4.5% change from baseline; 95% CI, -$460 to -$26; P = .03) and inpatient rehabilitation facilities (-22.9% change from baseline; 95% CI,-$497 to -$176; P < .001). Estimated savings on claims, while consistent with changes in practice patterns, may not have exceeded the reconciliation payments to hospitals reported by CMS to date. No significant changes in hospital length of stay, readmissions, complications, 30- or 90-day mortality, volume of episodes, or patient characteristics relative to control were found. CONCLUSIONS AND RELEVANCE The CJR was associated with reduced Medicare Part A spending on claims over 2 years, largely through lower postacute spending. Mandatory bundled payments may serve as a useful model for policy efforts to change clinicians' and facilities' behavior without harming quality.
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Affiliation(s)
| | | | | | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital, Boston
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15
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Feng JE, Padilla JA, Gabor JA, Cizmic Z, Novikov D, Anoushiravani AA, Bosco JA, Iorio R, Meftah M. Alternative Payment Models in Total Joint Arthroplasty: An Orthopaedic Surgeon's Perspective on Performance and Logistics. JBJS Rev 2019; 7:e5. [PMID: 31219998 DOI: 10.2106/jbjs.rvw.18.00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jorge A Padilla
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan A Gabor
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Zlatan Cizmic
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY.,Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, Michigan
| | - David Novikov
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY.,Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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16
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Meng Z, Zou K, Ding N, Zhu M, Cai Y, Wu H. Cesarean delivery rates, costs and readmission of childbirth in the new cooperative medical scheme after implementation of an episode-based bundled payment (EBP) policy. BMC Public Health 2019; 19:557. [PMID: 31088443 PMCID: PMC6515611 DOI: 10.1186/s12889-019-6962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In the past decade, the rate of cesarean delivery increased dramatically in rural China under the fee-for-service (FFS) system. In September 2011, the New Cooperative Medical Scheme (NCMS) agency in Yong'an county in Fujian province of China adopted a policy of reforming payment for childbirth by transforming the FFS payment into episode-based bundled payment (EBP), which made the cesarean deliveries less profitable. Thus, this study was conducted to determine the effect of EBP policy on reducing cesarean use and controlling delivery costs for rural patients in the NCMS. METHODS Data from the inpatient information database of the NCMS agency from January 2010 to March 2013 was collected, in which Yong'an county was employed as a reform county and 2 other counties as controls. We investigated the effects of EBP on cesarean delivery rate, costs of childbirth and readmission for rural patients in the NCMS using a natural experiment design and difference in differences (DID) analysis method. RESULTS The EBP reform was associated with 33.97% (p<0.01) decrease in the probability of cesarean delivery. The EBP reform, on average, reduced the total spending per admission, government reimbursement expenses per admission, and out-of-pocket (OOP) payments per admission by ¥ 649.61, ¥ 575.01, and ¥ 74.59, respectively. The OOP payments had a net decrease of 14.24% (p<0.01); whereas the OOP payments as a share of total spending had a net increase of 8.72% (p<0.01). There was no evidence of increase in readmission rates. CONCLUSIONS These results indicate that the EBP policy has achieved at least a short-term success in lowering the increase of cesarean delivery rate and costs of childbirth. Considering both the cesarean rate and the OOP payments as a share of total spending after the reform were still high, China still has a long way to go to achieve the ideal level of cesarean rate and improve the benefits of deliveries for rural population.
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Affiliation(s)
- Zhaolin Meng
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Kun Zou
- Department of Health Policy and Management, West China School of Public Health and Fourth West China Hospital, West China Research Centre for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Ning Ding
- Institute for International Healthcare Professionals Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Min Zhu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Yuanyi Cai
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China
| | - Huazhang Wu
- Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang, 110122, Liaoning, China.
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17
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Trombley MJ, McClellan SR, Kahvecioglu DC, Gu Q, Hassol A, Creel AH, Joy SM, Waldersen BW, Ogbue C. Association of Medicare's Bundled Payments for Care Improvement initiative with patient-reported outcomes. Health Serv Res 2019; 54:793-804. [PMID: 31038207 DOI: 10.1111/1475-6773.13159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether the Bundled Payments for Care Improvement (BPCI) initiative affected patient-reported measures of quality. DATA SOURCES Surveys of Medicare fee-for-service beneficiaries discharged from acute care hospitals participating in BPCI Model 2 and comparison hospitals between October 2014 and June 2017. Variables from Medicare administrative data and the Provider of Services file were used for sampling and risk adjustment. STUDY DESIGN We estimated risk-adjusted differences in patient-reported measures of care experience and changes in functional status, for beneficiaries treated by BPCI and comparison hospitals. DATA COLLECTION We selected a stratified random sample of BPCI and matched comparison beneficiaries. We fielded nine waves of surveys using a mail and phone protocol, yielding 29 193 BPCI and 29 913 comparison respondents. PRINCIPAL FINDINGS Most BPCI and comparison survey respondents reported a positive care experience and high satisfaction. BPCI respondents were slightly less likely than comparison respondents to report positive care experience or high satisfaction. Despite these differences in care experience, there was no difference between BPCI and comparison respondents in self-reported functional status approximately 90 days after hospital discharge. CONCLUSIONS These findings reduce concerns that BPCI may have unintentionally harmed patient health but suggest room for improvement in patient care experience.
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Affiliation(s)
- Matthew J Trombley
- Division of Health and Environment, Abt Associates, Durham, North Carolina
| | - Sean R McClellan
- Division of Health and Environment, Abt Associates, Cambridge, Massachusetts
| | - Daver C Kahvecioglu
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Qian Gu
- KPMG, Economic and Valuation Services, McClean, Virginia
| | - Andrea Hassol
- Division of Health and Environment, Abt Associates, Cambridge, Massachusetts
| | | | | | - Brian W Waldersen
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Christine Ogbue
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
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18
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Navathe AS, Liao JM, Polsky D, Shah Y, Huang Q, Zhu J, Lyon ZM, Wang R, Rolnick J, Martinez JR, Emanuel EJ. Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs. Health Aff (Millwood) 2019; 37:854-863. [PMID: 29863929 DOI: 10.1377/hlthaff.2017.1358] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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 exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.
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Affiliation(s)
- Amol S Navathe
- Amol S. Navathe ( ) is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Joshua M Liao
- Joshua M. Liao is an assistant professor in the Department of Medicine at the University of Washington School of Medicine, in Seattle
| | - Daniel Polsky
- Daniel Polsky is the Robert D. Eilers Professor in Health Care Management and Economics and executive director of the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania
| | - Yash Shah
- Yash Shah is a research assistant in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Qian Huang
- Qian Huang is a statistical analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Jingsan Zhu
- Jingsan Zhu is assistant director of data analytics in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Zoe M Lyon
- Zoe M. Lyon is a senior research coordinator, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
| | - Robin Wang
- Robin Wang is an undergraduate student in the College of Arts and Sciences, Cornell University, in Ithaca, New York
| | - Josh Rolnick
- Josh Rolnick is an associate fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Joseph R Martinez
- Joseph R. Martinez is an MD-PhD student in the Perelman School of Medicine, University of Pennsylvania
| | - Ezekiel J Emanuel
- Ezekiel J. Emanuel is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania
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19
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Barnett ML, Wilcock A, Mc Williams JM, Epstein AM, Maddox KEJ, Orav EJ, Grabowski DC, Mehrotra A. Two-Year Evaluation of Mandatory Bundled Payments for Joint Replacement. N Engl J Med 2019; 380:252-262. [PMID: 30601709 PMCID: PMC6504974 DOI: 10.1056/nejmsa1809010] [Citation(s) in RCA: 193] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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 metropolitan statistical areas. Hospitals in such areas receive bonuses or pay penalties based on Medicare spending per hip- or knee-replacement episode (defined as the hospitalization plus 90 days after discharge). METHODS We conducted difference-in-differences analyses using Medicare claims from 2015 through 2017, encompassing the first 2 years of bundled payments in the CJR program. We evaluated hip- or knee-replacement episodes in 75 metropolitan statistical areas randomly assigned to mandatory participation in the CJR program (bundled-payment metropolitan statistical areas, hereafter referred to as "treatment" areas) as compared with those in 121 control areas, before and after implementation of the CJR model. The primary outcomes were institutional spending per hip- or knee-replacement episode (i.e., Medicare payments to institutions, primarily to hospitals and post-acute care facilities), rates of postsurgical complications, and the percentage of "high-risk" patients (i.e., patients for whom there was an elevated risk of spending - a measure of patient selection). Analyses were adjusted for the hospital and characteristics of the patients and procedures. RESULTS From 2015 through 2017, there were 280,161 hip- or knee-replacement procedures in 803 hospitals in treatment areas and 377,278 procedures in 962 hospitals in control areas. After the initiation of the CJR model, there were greater decreases in institutional spending per joint-replacement episode in treatment areas than in control areas (differential change [i.e., the between-group difference in the change from the period before the CJR model], -$812, or a -3.1% differential decrease relative to the treatment-group baseline; P<0.001). The differential reduction was driven largely by a 5.9% relative decrease in the percentage of episodes in which patients were discharged to post-acute care facilities. The CJR program did not have a significant differential effect on the composite rate of complications (P=0.67) or on the percentage of joint-replacement procedures performed in high-risk patients (P=0.81). CONCLUSIONS In the first 2 years of the CJR program, there was a modest reduction in spending per hip- or knee-replacement episode, without an increase in rates of complications. (Funded by the Commonwealth Fund and the National Institute on Aging of the National Institutes of Health.).
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Affiliation(s)
| | | | - J. Michael Mc Williams
- Department of Health Care Policy, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Karen E. Joynt Maddox
- Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - E. John Orav
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | | | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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20
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Offodile AC, Mehtsun W, Stimson CJ, Aloia T. An Overview of Bundled Payments for Surgical Oncologists: Origins, Progress to Date, Terminology, and Future Directions. Ann Surg Oncol 2018; 26:3-7. [DOI: 10.1245/s10434-018-7037-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Indexed: 12/19/2022]
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21
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Liao JM, Chu D, Navathe AS. Succeeding in New Cardiac Bundles: Lessons from History, Directions for the Future. Ann Surg 2018; 268:938-9. [PMID: 29916869 DOI: 10.1097/SLA.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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