Literature Review

Bundled payments reduce costs in joint patients


Clinical question: Does bundled payment for lower extremity joint replacement (LEJR) reduce cost without compromising the quality of care?

Background: Conventionally, Medicare makes separate payments to providers for the individual services rendered to patients. The Bundled Payments for Care Improvement (BPCI) program was developed to align incentives for providers across all specialties. LEJR is the most common Medicare inpatient procedure, costing more than $6 billion in 2014.

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. JAMA. 2016;316(12):1267-1278.

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.

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