Key result
Medicare's Nonpayment Program was associated with a 44-53% reduction in VTE incidence after hip replacements and a 47% reduction after knee replacements in hospitals with higher Medicare utilization.
Why the study?
Does Medicare's Nonpayment Program reduce the occurrence of venous thromboembolism following hip and knee replacements?
Observational (n=210,090)
Yes
Does Medicare's Nonpayment Program reduce the occurrence of venous thromboembolism following hip and knee replacements?
Medicare's Nonpayment Program was associated with a significant reduction in VTE incidence following hip and knee replacements, particularly in hospitals with higher Medicare utilization.
Answers are grounded in this paper and cite their sources.
Supports exploration of nonpayment incentives to lower post-arthroplasty VTE; leaves open causality and generalizability beyond high-Medicare hospitals.
OBJECTIVE: To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program. DATA SOURCES: State Inpatient Database for New York (NY) from 2005 to 2013. STUDY DESIGN: The primary outcome was an occurrence of VTE. Medicare Utilization Ratio (MUR), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity. We used hierarchical logistic regressions with difference-in-differences estimation to study the Program effects. PRINCIPAL FINDINGS: A total of 98,729 hip replacement and 111,361 knee replacement stays were identified. For hip replacement, the Program was associated with significant reduction (Range: 44% to 53%) in VTE incidence among hospitals in MUR quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in VTE incidence only among quartile 2 hospitals. CONCLUSION: Implementation of the Program was associated with a reduction in VTE, especially for hip replacements, in higher MUR hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.
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Thirukumaran et al. (2018) conducted an observational in Hip and knee replacements (n=210,090). Medicare's Nonpayment Program vs. Pre-program period / lower Medicare Utilization Ratio hospitals was evaluated on Occurrence of venous thromboembolism (VTE) (44% to 53% reduction (hip) and 47% reduction (knee)). Medicare's Nonpayment Program was associated with a 44-53% reduction in VTE incidence after hip replacements and a 47% reduction after knee replacements in hospitals with higher Medicare utilization.
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