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September 04, 2018
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BPCI participation not correlated with market-level lower-extremity joint replacement volume

Hospital participation in Bundled Payments for Care Improvement was not correlated with changes in market-level lower-extremity joint replacement volume and with changes in hospital case mix, according to results published in JAMA.

“[This] study provides good news for bundled payments as a policy to increase health care value,” Amol S. Navathe, MD, told Healio.com/Orthopedics. “The findings that hospitals and physicians are not ramping up procedural volume that offsets savings to Medicare and that there aren’t big systematic changes in the characteristics of Medicare patients receiving hip and knee replacements reinforce that bundled payment may be good policy.”

With Medicare claims data and a difference-in-difference method, researchers compared 131 markets with at least one Bundled Payments for Care Improvement (BPCI) participant hospital with 175 markets with no participating hospitals. This accounted for 580,043 Medicare beneficiaries treated before and 462,161 Medicare beneficiaries treated after the implementation of the BPCI initiative. There were 265 participating hospitals compared with a 1:1 propensity-matched set of nonparticipating hospitals from non-BPCI markets to assess the hospital-level case-mix changes. Other outcomes measured included the changes in the market-level lower-extremity joint replacement surgery volume before and after BPCI periods.

Results showed BPCI participation was not significantly correlated with a change in the overall market-level volume among the 1,717,243 Medicare beneficiaries who underwent lower-extremity joint replacement surgery. Investigators noted that the mean quarterly market volume in non-BPCA markets increased from 3.8 episodes per 1,000 beneficiaries before BCPI to 3.9 episodes per 1,000 beneficiaries after BCPI was launched, a 3.8% increase. – by Monica Jaramillo

 

Disclosures: Navathe reports he receives grant support from Hawaii Medical Service Association and Oscar Health; personal fees from Navvis and Co., Navigant Inc., Lynx Medical, Indegene Inc. and Sutherland Global Services; and honoraria from Elsevier Pressper. Please see the study for all other authors’ relevant financial disclosures.

 

Sources/Disclosures

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Source:

Navathe AS, et al. JAMA. 2018;doi:10.1001/jama.2018.12345.