Clinical question: Does bundled payment for lower extremity joint replacement (
Study design: Observational study.
Setting: BPCI-participating hospitals.
Synopsis: At BPCI-participating hospitals, there were 29,441 LEJR episodes in the baseline period and 31,700 episodes in the intervention period; these were compared with a control group of 29,440 episodes in the baseline period and 31,696 episodes in the intervention period. The BPCI initiative was associated with a significant reduction in Medicare per-episode payments, which declined by an estimated $1,166 more (95% confidence interval, –$1634 to –$699; P less than .001) for the BPCI group than for the comparison group (between baseline and intervention periods).
There were no statistical differences in claims-based quality measures between the BPCI and comparison populations, which included 30- and 90-day unplanned readmissions, ED visits, and postdischarge mortality.
Bottom line: Bundled payments for joint replacements may have the potential to decrease cost while maintaining quality of care.
Citation: Dummit L, Kahvecioglu D, Marrufo G, et al. Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint e replacement episodes.
Dr. Briones is an assistant professor at the University of Miami Miller School of Medicine and medical director of the hospitalist service at the University of Miami Hospital.