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Mandatory orthopedic bundle payment programs may produce more robust evidence
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Although voluntary and mandatory programs may help engage hospitals in bundled payment, results published in Health Affairs showed mandatory programs produced more robust, generalizable evidence.
To compare characteristics and baseline performance among hospitals in Medicare’s voluntary initiative Bundled Payments for Care Improvement (BPCI) and mandatory Comprehensive Care for Joint Replacement (CJR) joint replacement programs, Amol S. Navathe, MD, and colleagues analyzed data from Medicare and the American Hospital Association Annual Survey.
Results showed BPCI hospitals tended to be significantly larger and have a larger mean annual Medicare patient volume vs. CJR hospitals. Researchers also found BPCI hospitals were more likely to be not-for-profit, teaching hospitals and sole community providers. However, BPCI hospitals were less likely to be safety-net hospitals, according to results.
Researchers noted BPCI and CJR hospitals had a similar breakdown of baseline episode spending for major joint replacement or re-attachment of lower extremity without major complicating or comorbid condition. However, results showed greater spending on post-acute care provided by inpatient rehabilitation facilities and home health agencies but not skilled nursing facilities, as well as marginally lower spending attributable to outpatient facility services and durable medical equipment among BPCI hospitals. In comparison, researchers found significantly greater baseline spending for inpatient rehabilitation facilities, skilled nursing facilities, home health agencies and professional fees among CJR mandate hospitals.
“Voluntary and mandatory bundled payment engage different hospital types, and so one program type is not going to garner enough participation,” Navathe told Healio.com/Orthopedics. – by Casey Tingle
Disclosures: Navathe reports he serves as adviser to Navvis and Company, Navigant Inc. and Indegene Inc.; received honorarium from Elsevier Press; and receives grant funding from Oscar Health Insurance and Hawaii Medical Services Association. Please see the full study for all other authors’ relevant financial disclosures.
Perspective
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François de Brantes
The argument for mandatory bundled payment programs are that 1) they prevent the potential for selecting the “crème of the crop” and punting other patients and 2) they create a broader natural experiment from which to evaluate the effects of the program, making the results more generalizable.
The arguments for voluntary bundled programs are that 1) they provide an ability to iterate and change as effects of the program are observed and 2) they engage providers that want to be engaged and may, as a result, invest more in the needed care transformation.
Both arguments have merit but, in balance, until such time that as a country we feel we’ve cracked the code on the type of payment that will deliver the best incentives and providers have organized into systems that provide the best outcomes, we should continue to favor voluntary over mandatory.
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