HealthDay News—For lower extremity joint replacement, Medicare payments declined more for episodes provided at Bundled Payments for Care Improvement (BPCI)-participating hospitals, according to a study published online September 19 in the Journal of the American Medical Association.

Laura A. Dummit, MSPH, from The Lewin Group in Falls Church, Va., and colleagues estimated the differential change in outcomes for Medicare fee-for-service beneficiaries who had a lower extremity joint replacement at a BPCI-participating hospital between the baseline and intervention periods (29,441 and 31,700 procedures, respectively, at 176 hospitals). Outcomes were compared for beneficiaries with the same surgical procedure at matched comparison hospitals (29,440 episodes at 768 hospitals in the baseline period and 31,696 episodes at 841 hospitals in the intervention period).

The researchers found that the BPCI mean Medicare episode payments were $30,551 in the baseline period, and decreased to $27,265 in the intervention period. In comparison hospitals, the mean Medicare episode payments were $30,057 in the baseline period, and decreased to $27,938. For BPCI episodes, the mean Medicare episode payments declined by an estimated $1,166 more, mainly due to reduced use of institutional post-acute care. There were no significant differences in the claim-based quality measures, including 30- and 90-day unplanned readmissions, 30- and 90-day emergency department visits, and 30- and 90-day post-discharge mortality.

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“Further studies are needed to assess longer-term follow-up as well as patterns for other types of clinical care,” the authors write.

Several authors are employed by The Lewin Group and its subsidiaries and subcontractors; the Lewin Group funded the study.

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  1. Dummit LA, Kahvecioglu D, Marrufo G, et al. Association between hospital participation in Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA. 2016; doi: 10.1001/jama.2016.12717
  2. Fisher ES. Medicare’s bundled payment program for joint replacement. Promise and peril? JAMA. 2016; doi: 10.1001/jama.2016.12525