Hospitals slightly reduced spending under Medicare's bundled joint replacement model — 5 insights

Medicare's mandatory bundled payments for joint replacement created modest savings per hip or knee replacement episode without increasing complications, according to research published in The New England Journal of Medicine.

Hospitals in 75 metropolitan areas that participated in the Comprehensive Care for Joint Replacement program received bonuses or paid penalties based on Medicare spending per episode, which was defined as the hospitalization plus 90 days post-discharge. Researchers analyzed Medicare claims from 2015 through 2017, the first two years of the bundled payments. Hip- or knee-replacement episodes in the 75 metropolitan areas were compared with episodes in 121 control areas, before and after the CJR model was implemented.

Here's what you should know:

1. After the CJR model was implemented, there were greater decreases in institutional spending per joint-replacement episode in participating areas than in control areas.

2. The metropolitan areas reduced spending by about $812 per joint-replacement episode in the model's first two years.

3. There was a 5.9 percent decrease in the percentage of episodes involving patients being discharged to post-acute care facilities.

4. The model didn't significantly impact the composite rate of complications or the percentage of joint-replacement procedures performed on high-risk patients.

5. The Commonwealth Fund and the National Institute on Aging of the National Institutes of Health funded the study.

More articles on orthopedics/TJR:
Dr. Kamran Hamid: 3 lessons learned from starting a value-based orthopedic clinic
Patients with sleep apnea more likely to experience complications after total joint arthroplasty: 3 study details
Some patients dissatisfied with knee replacement outcomes — 6 takeaways

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