June 27, 2023

Effect of private insurer bundled payment program for total joints on outcomes

Editor's Note

This multi-center study led by Humana Inc, Louisville, Kentucky, finds that a bundled payment program offered by a Medicare Advantage insurer for lower extremity joint replacements was associated with reduced spending without changes in quality.

A total of 23,034 lower extremity joint replacement surgical episodes (6,355 bundled, 16,679 controls) from 109 physician practices were included in the analysis.

Participation in the bundled payment program was associated with:

  • a 2.7% decrease in spending per episode ($21, 964 for bundled vs $22,562 for controls)
  • reductions in skilled nursing facility use after discharge (21.3% for bundled vs 25.0% for controls)
  • an increased use of the outpatient surgical setting (14.1% for bundled vs 8.4% for controls)
  • no changes in quality outcomes, including 90-day complications (8.8% for bundled vs 8.6% for controls) and readmissions (4.3% for bundled vs 4.6% for controls).

The researchers concluded that bundled payments offered by private insurers, including Medicare Advantage plans, may reduce spending for lower extremity joint replacements while maintaining quality of care.


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