Association of Medicare Mandatory Bundled Payment System for Hip and Knee Joint Replacement With Racial/Ethnic Difference in Joint Replacement Care

Kim, Hyunjee; Meath, Thomas H. A.; Tran, Felix W; Quiñones, Ana; McConnell, K. John; Ibrahim, Said A.

doi:10.1001/jamanetworkopen.2020.14475

Cited by 21 publications

(18 citation statements)

References 36 publications

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“…41 The findings of this study represent relative improvements despite concerns that value-based payment models may exacerbate existing disparities. 41 Further timetrend patient demographic studies are needed to explore trends in socioeconomic status disparities in patients undergoing primary THA. This study is not without limitations.…”

Section: Demographicsmentioning

confidence: 76%

“…41 In a retrospective cohort of Medicare claims from 2013 to 2017 among Caucasian, African American, and Hispanic patients undergoing TJA, Kim et al 41 found CJR was associated with decreased readmissions for African American patients with African American patients experiencing a greater decrease in discharges to post-acute facilities relative to Caucasian patients. 41 The findings of this study represent relative improvements despite concerns that value-based payment models may exacerbate existing disparities. 41 Further time-trend patient demographic studies are needed to explore trends in socioeconomic status disparities in patients undergoing primary THA.…”

Section: Discussionmentioning

confidence: 99%

“…Bundled programs can potentially change care for African American and Hispanic patients more than for Caucasian patients and thus decrease racial/ethnic differences in joint replacement care. 41 In a retrospective cohort of Medicare claims from 2013 to 2017 among Caucasian, African American, and Hispanic patients undergoing TJA, Kim et al 41 found CJR was associated with decreased readmissions for African American patients with African American patients experiencing a greater decrease in discharges to post-acute facilities relative to Caucasian patients. 41 The findings of this study represent relative improvements despite concerns that value-based payment models may exacerbate existing disparities.…”

Section: Demographicsmentioning

confidence: 99%

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Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Warren

Barsoum

Mont

et al. 2021

The Journal of Hip Surgery

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Background While previous studies have provided insight into time-trends in age and comorbidities of total hip arthroplasty (THA) patients, there is limited recent literature from within the past decade. The implication of these findings is relevant due to the projected THA volume increase and continued emphasis on healthcare system cost-containment policies. Therefore, the purpose of this study was to identify trends in THA patient demographics, comorbidities, and episode of care from 2008 to 2018. Methods The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographics, comorbidities, and episodes of care outcomes in patients undergoing primary THA from 2008 to 2018 (n = 216,524). Trends were analyzed using analysis of variances for continuous variables, while categorical variables were analyzed using chi-squared or Monte Carlo tests, where applicable. Results From 2008 to 2018, there were no clinically significant differences in age and body mass index (BMI) in patients with BMI over 40 kg/m2. However, modifiable comorbidities including patients with hypertension (60.2% in 2008, 54.3 in 2018%, p < 0.001) and anemia (19% in 2008, 11.2%, in 2016, p < 0.001) improved. Functional status and the overall morbidity probability have improved with a decrease in hospital lengths of stay (4.0 ± 2.8 days in 2008, 2.1 ± 2.2 days in 2018, p < 0.001), 30-day readmissions (4.2% in 2009, 3.3% in 2018, p < 0.001), and significant increase in home-discharges (70.1% in 2008, 87.3% in 2018, p < 0.001). Conclusion Patient overall health status improved from 2008 to 2018. While conjectural, our findings may be a reflection of a global shift toward value-based comprehensive care centering on patient optimization prior to arthroplasty, quality-of-care, and curtailing costs by mitigating perioperative adverse events.This study's level of evidence is III.

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Section: Demographicsmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Demographicsmentioning

confidence: 99%

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Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Warren

Barsoum

Mont

et al. 2021

The Journal of Hip Surgery

View full text Add to dashboard Cite

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“…Our study included hospitals in 67 MSAs randomly selected by CMS to participate in the CJR model, along with hospitals from 103 control MSAs eligible for the model but not selected to participate. 7 Our study excluded joint replacement surgeries ineligible for CJR model participation (eg, people with Medicare as a secondary payer and hospitals in the Bundled Payments for Care Improvement initiative for joint replacement). We also excluded surgeries for patients with less than 12 months of enrollment prior to the surgery or less than 3 months following the surgery to ensure sufficient time to capture outcomes and health characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…We defined institutional postacute care services as any services provided in a skilled nursing facility, swing bed, inpatient rehabilitation facility, or long-term care hospital. 7 We adjusted spending for cost of living using the CMS wage index 8 and for inflation using the Consumer Price Index. 9…”

Section: Methodsmentioning

confidence: 99%

Hospital Characteristics Associated With Heterogeneity in Institutional Postacute Care Spending Reductions Under the Comprehensive Care for Joint Replacement Model

et al. 2022

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Key Points Question How were hospital characteristics associated with reductions in institutional postacute care spending under the Comprehensive Care for Joint Replacement (CJR) model? Findings This cross-sectional study of 531 CJR participating hospitals and 658 control group hospitals did not find strong evidence for significant heterogeneity in how CJR was associated with reductions in institutional postacute care spending across a range of hospital characteristics. Meaning Reductions in institutional postacute care spending under the CJR model did not appear concentrated among a single hospital group or characteristics, suggesting that this payment model created opportunities for savings across a spectrum of different hospitals.

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Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries

et al. 2021

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Key Points Question Is the Medicare Comprehensive Care for Joint Replacement (CJR) model associated with the receipt of elective hip or knee replacement surgery in White, Black, and Hispanic beneficiaries? Findings In this cohort study of 49 595 269 beneficiary-year observations from 17 243 304 patients, the CJR model was associated with increases in the receipt of elective hip or knee replacement for Hispanic beneficiaries, decreases for Black beneficiaries, and no changes for White beneficiaries. Meaning In this study, the decrease in the receipt of hip or knee replacement among Black beneficiaries suggests a need for value-based payment models to be monitored for unintended consequences; the lack of similar findings among Hispanic beneficiaries may indicate that payment models have differential associations across racial/ethnic groups.

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Association of Medicare Mandatory Bundled Payment System for Hip and Knee Joint Replacement With Racial/Ethnic Difference in Joint Replacement Care

Abstract: This cohort study analyzes Medicare claims data to assess whether changes in joint replacement care are associated with Medicare’s Comprehensive Care for Joint Replacement (CJR) model among White, Black, and Hispanic patients.

Cited by 21 publications

References 36 publications

Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Hospital Characteristics Associated With Heterogeneity in Institutional Postacute Care Spending Reductions Under the Comprehensive Care for Joint Replacement Model

Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries

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