February 24, 2020

Effect of total joint bundled payment program on patient selection

By: Judy Mathias
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Editor's Note

In this study, researchers found little to no significant change in the characteristics of patients having total hip and knee replacement surgery after the Centers for Medicare & Medicaid Services introduced the mandatory bundled payment programs in selected metropolitan statistical areas.

The analysis included a matched set of more than 12,000 episodes of hip and knee replacement and follow-up care for patients in bundled payment areas and 20,000 episodes in other areas.


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After adjusting for age and gender, there were no significant differences in characteristics of patients in bundled payment areas, compared with areas with no change in reimbursement.

Further analysis that controlled for risk factors for complications, such as general health, smoking, or diabetes, showed not change in the proportion of patients who were black or low-income.

Earlier analyses of Medicare’s Comprehensive Care for Joint Replacement program showed cost savings, but they also showed a trend toward the selection of healthier patients for total hips and knees performed under the bundled system.

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