Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.

To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. We used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. We conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program. The primary outcome was LEJR complications. Secondary outcomes included 90-day readmissions and mortality. We identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control. The study included 1,603,555 Medicare beneficiaries (mean age, 74.6 years, 64.3% women, 11.0% dual-eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual-eligible and 7.0% to 6.4% for non-dual-eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual-eligible and 6.7% to 6.0% for non-dual-eligible beneficiaries. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points, 95% CI -1.6 to -0.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90-day readmissions or mortality. Mandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medicare beneficiaries with low income. To our knowledge, this is the first evidence of reduced socioeconomic disparities in outcomes under value-based payments.

Kilaru AS ，Liao JM ，Wang E ，Zhao Y ，Zhu J ，Ng G ，Shirk T ，Cousins DS ，Kanter GP ，Ibrahim S ，Navathe AS ... -  《-》

Association of the Comprehensive Care for Joint Replacement Model With Disparities in the Use of Total Hip and Total Knee Replacement.

Thirukumaran CP ，Kim Y ，Cai X ，Ricciardi BF ，Li Y ，Fiscella KA ，Mesfin A ，Glance LG ... -  《JAMA Network Open》

Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care: Interim Analysis of the First Year of a 5-Year Randomized Trial.

Finkelstein A ，Ji Y ，Mahoney N ，Skinner J ... -  《-》

Association of Hospital Participation in a Medicare Bundled Payment Program With Volume and Case Mix of Lower Extremity Joint Replacement Episodes.

Navathe AS ，Liao JM ，Dykstra SE ，Wang E ，Lyon ZM ，Shah Y ，Martinez J ，Small DS ，Werner RM ，Dinh C ，Ma X ，Emanuel EJ ... -  《-》

Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations.

Liao JM ，Emanuel EJ ，Venkataramani AS ，Huang Q ，Dinh CT ，Shan EZ ，Wang E ，Zhu J ，Cousins DS ，Navathe AS ... -  《JAMA Network Open》