June 11, 2018
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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.

Amol S. Navathe

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.