What question did this study set out to answer?

To determine the association of mandatory bundled payments for joint replacement surgical procedures with the use of postacute care services among Medicare Advantage patients.

December 27, 2019JAMA Network OpenOpen Access

Association of Mandatory Bundled Payments for Joint Replacement With Use of Postacute Care Among Medicare Advantage Enrollees

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To determine the association of mandatory bundled payments for joint replacement surgical procedures with the use of postacute care services among Medicare Advantage patients.
Cohort study using difference-in-differences analysis evaluating Medicare enrollees undergoing knee and hip replacements from January 1, 2013, to September 30, 2017.
Analyzed 1,536,387 individuals across 75 metropolitan statistical areas randomized to bundled payments and 121 control areas.
The primary outcomes assessed were discharge to any institutional postacute care setting and total days spent in institutional postacute care within 90 days of surgery.
Among 493,977 Medicare Advantage patients, bundled payments were associated with a 1.5 percentage point reduction in institutional postacute care discharge (95% CI, 1.0-2.0; P < .001) and a 0.3-day reduction in institutional stay (95% CI, 0.2-0.5; P < .001), representing a 5.6% relative reduction.
Among 1,042,410 traditional Medicare patients, bundled payments were associated with a 2.6 percentage point reduction in discharge to institutional care (95% CI, 2.2-2.9; P < .001) and a 0.8-day decrease in time spent (95% CI, 0.7-0.9; P < .001), a 2.5% relative reduction.
Reductions in postacute care duration were larger in hospitals serving lower proportions of Medicare Advantage patients (0.9-day decrease in traditional Medicare and 0.8-day decrease in Medicare Advantage) compared to hospitals with high concentrations (0.6-day and 0.2-day decreases, respectively).

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Implication

Cohort study reveals reduced institutional postacute care use among Medicare Advantage enrollees, indicating spillover effects from hospital payment reforms.

Cite This Study

Meyers et al. (2019) studied this question.

synapsesocial.com/papers/6a8c2bc1c17aa55aa6e8cf4f https://doi.org/10.1001/jamanetworkopen.2019.18535

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Implication

Cohort study reveals reduced institutional postacute care use among Medicare Advantage enrollees, indicating spillover effects from hospital payment reforms.

Association of Mandatory Bundled Payments for Joint Replacement With Use of Postacute Care Among Medicare Advantage Enrollees

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Discussion

Implication

Cite This Study

Association of Mandatory Bundled Payments for Joint Replacement With Use of Postacute Care Among Medicare Advantage Enrollees

Key Points

Discussion

Implication

Cite This Study

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