Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs

Amol S Navathe¹, Joshua M Liao², Daniel Polsky³, Yash Shah⁴, Qian Huang⁵, Jingsan Zhu⁶, Zoe M Lyon⁷, Robin Wang⁸, Josh Rolnick⁹, Joseph R Martinez¹⁰, Ezekiel J Emanuel¹¹

Affiliations

¹ Amol S. Navathe ( amol@pennmedicine.upenn.edu ) is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
² Joshua M. Liao is an assistant professor in the Department of Medicine at the University of Washington School of Medicine, in Seattle.
³ Daniel Polsky is the Robert D. Eilers Professor in Health Care Management and Economics and executive director of the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
⁴ Yash Shah is a research assistant in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁵ Qian Huang is a statistical analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁶ Jingsan Zhu is assistant director of data analytics in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁷ Zoe M. Lyon is a senior research coordinator, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁸ Robin Wang is an undergraduate student in the College of Arts and Sciences, Cornell University, in Ithaca, New York.
⁹ Josh Rolnick is an associate fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
¹⁰ Joseph R. Martinez is an MD-PhD student in the Perelman School of Medicine, University of Pennsylvania.
¹¹ Ezekiel J. Emanuel is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania.

PMID: 29863929
PMCID: PMC7703802
DOI: 10.1377/hlthaff.2017.1358

Comparative Study

Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs

Amol S Navathe et al. Health Aff (Millwood). 2018 Jun.

. 2018 Jun;37(6):854-863.

doi: 10.1377/hlthaff.2017.1358.

Authors

Amol S Navathe¹, Joshua M Liao², Daniel Polsky³, Yash Shah⁴, Qian Huang⁵, Jingsan Zhu⁶, Zoe M Lyon⁷, Robin Wang⁸, Josh Rolnick⁹, Joseph R Martinez¹⁰, Ezekiel J Emanuel¹¹

Affiliations

¹ Amol S. Navathe ( amol@pennmedicine.upenn.edu ) is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
² Joshua M. Liao is an assistant professor in the Department of Medicine at the University of Washington School of Medicine, in Seattle.
³ Daniel Polsky is the Robert D. Eilers Professor in Health Care Management and Economics and executive director of the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
⁴ Yash Shah is a research assistant in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁵ Qian Huang is a statistical analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁶ Jingsan Zhu is assistant director of data analytics in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁷ Zoe M. Lyon is a senior research coordinator, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁸ Robin Wang is an undergraduate student in the College of Arts and Sciences, Cornell University, in Ithaca, New York.
⁹ Josh Rolnick is an associate fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
¹⁰ Joseph R. Martinez is an MD-PhD student in the Perelman School of Medicine, University of Pennsylvania.
¹¹ Ezekiel J. Emanuel is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania.

PMID: 29863929
PMCID: PMC7703802
DOI: 10.1377/hlthaff.2017.1358

Abstract

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare's voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.

Keywords: Financing Health Care; Health Reform; Hospitals; Medicare; Organization and Delivery of Care.

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Figures

**Exhibit 1**
Hospital participation in Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative and mandatory Comprehensive Care for Joint Replacement (CJR) program in 2016, by Metropolitan Statistical Area **Source:** SOURCE Authors’ analysis of data for 2013–15 from the American Hospital Association Annual Survey and of publicly available Medicare data for 2013–16 on bundled payment program participants.

**Exhibit 4**
Average episode spending breakdown by component for major hip and knee joint replacement for hospitals participating in the Bundled Payments for Care Improvement (BPCI) initiative and Comprehensive Care for Joint Replacement (CJR) program, 2016 **Source/Notes:** SOURCE Authors’ analysis of Medicare claims data for 2010–16. NOTES Episode spending is for Medicare Severity–Diagnosis-Relate Group (MS-DRG) 470, major hip and knee joint replacement or reattachment of lower extremity without a major complicating or comorbid condition. Other inpatient facilities include long-term acute care facilities, inpatient psychiatric facilities, and critical access hospitals.

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References

1. CMS.gov. Bundled Payments for Care Improvement (BPCI) initiative: general information [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last updated 2018 Feb 16; cited 2018 Mar 8]. Available from: https://innovation.cms.gov/initiatives/bundled-payments/
1. Centers for Medicare and Medicaid Services. Medicare Program; cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P). Federal Register [serial on the Internet]. 2017. August 17 [cited 2018 Mar 7]. Available from: https://www.gpo.gov/fdsys/pkg/FR-2017-08-17/pdf/2017-17446.pdf - PubMed
1. Centers for Medicare and Medicaid Services. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for acute care hospitals furnishing lower extremity joint replacement services. Final rule. Fed Regist. 2015;80(226):73273–554. - PubMed
1. Dummit LA, Kahvecioglu D, Marrufo G, Rajkumar R, Marshall J, Tan E, et al. Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA. 2016;316(12):1267–78. - PubMed
1. Navathe AS, Troxel AB, Liao JM, Nan N, Zhu J, Zhong W, et al. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214–22. - PubMed

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Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs

Affiliations

Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs

Authors

Affiliations

Abstract

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References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical