Bundled payment model may increase home discharge rates for underrepresented groups
Click Here to Manage Email Alerts
Key takeaways:
- The Comprehensive Care for Joint Replacement model was associated with increased rates of home discharge for Hispanic patients.
- Rates of home discharge were compared with white patients.
Published results showed the Comprehensive Care for Joint Replacement model, a Medicare bundled payment program, may be associated with increased rates of home discharge for Hispanic patients compared with white patients.
“These findings suggest that the [Comprehensive Care for Joint Replacement] CJR model may increase home discharge rates among Hispanic patients outside of traditional Medicare and thereby reduce discrepancy in post-acute care,” Narae Kim, PhD, from the Leonard Davis School of Gerontology at the University of Southern California, and colleagues wrote in the study.
To assess the impact of the CJR model on length of stay and rates of home discharge for patients of varying races and ethnicities, Kim and colleagues used the California patient discharge dataset to study data from 309,834 total joint arthroplasties performed between 2014 and 2017.
The treatment group consisted of 48% of patients who were enrolled from three metropolitan statistical areas in California, which were randomly selected to participate in the CJR model in April 2016. The control group consisted of 52% of patients who were enrolled from the remaining 23 metropolitan statistical areas. Among the control group, 26.8% of patients had Medicare Advantage, 36.1% of patients had traditional Medicare and 37.1% were not covered by Medicare.
Overall, Kim and colleagues found the CJR model was associated with significantly increased rates of home discharge for patients who did not have traditional Medicare coverage. However, they found the impact of the CJR program varied by patients’ race and ethnicity.
Compared with white patients, rates of home discharge increased by 0.05 percentage points for Hispanic patients with Medicare Advantage and by 0.03 percentage points for Hispanic patients without Medicare.
“Importantly, our findings cannot show whether the differential changes associated with the CJR policy were positive or negative,” Kim and colleagues wrote. “For example, the larger increase in home discharge rates among Hispanic patients does not necessarily equate to an improvement in well-being or treatment quality.”
“These findings suggest the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups,” Kim and colleagues concluded.
Perspective
Back to Top
Kevin J. Bozic, MD, MBA, FACS, FAAOS, FAOA
The study on outcomes by race and ethnicity following the implementation of the Medicare Comprehensive Care for Joint Replacement (CJR) program highlights important differences in health equity in Medicare beneficiaries who undergo lower extremity joint arthroplasty. Notably, Hispanic patients outside of traditional Medicare who participated in the CJR experienced a greater increase in home discharge rates than their non-Hispanic white counterparts. This suggests that the CJR model may help bridge existing disparities in the utilization of post-acute care, especially in California, where Hispanic patients represent a significant portion of the Medicare population.
However, these findings also raise questions. While increased home discharge rates may reduce episode spending for lower extremity joint replacement procedures, it is unclear if these changes correlate with better patient outcomes as defined by improvements in pain, functional status and quality of life. Furthermore, Hispanic patients, historically facing lower home discharge rates, may have had more potential for improvement. Without adequate follow-up on patient outcomes post-discharge, we cannot fully understand whether the change in home discharge rates correlates with improvement in the outcomes that ultimately matter the most to Hispanic patients who undergo lower extremity joint replacement.
This research underscores the need for continued exploration of how value-based payment models impact health disparities and ensure that bundled payment policies do not inadvertently reinforce existing health inequities across different populations.
Collapse
Click Here to Manage Email Alerts