The Impact of Medicare Bundled Payments

Amy Finkelstein

Status

Completed

Conditions

Arthroplasty, Replacement

Treatments

Other: Bundled payments for knee and hip replacement

Study type

Interventional

Funder types

Other

Identifiers

NCT03407885

JPAL-0740

Details and patient eligibility

About

Bundled payments (BP) are a key part of Medicare's shift away from the traditional fee-for-service (FFS) payment model. The investigators propose to study a nationwide randomized-controlled trial (RCT) of bundled payments for knee and hip replacements that was designed and implemented by CMS and launched in April 2016. Randomization was conducted at the Metropolitan Statistical Area (MSA) level with 67 MSAs and about 800 hospitals assigned to the treatment group. The investigators will examine the impact of bundled payments on Medicare spending, utilization, and quality. Study findings should be directly relevant for the design of payments for knee and hip replacements, two common and expensive medical procedures. Average impacts, as well as variation in impact across types of providers and markets may also shed light on economic mechanisms, which should be relevant for bundled payment initiatives under consideration for other medical services.

Enrollment

196 patients

Sex

All

Volunteers

No Healthy Volunteers

Inclusion criteria

Acute care hospital paid under the inpatient prospective payment system (IPPS)
Hospital admission for major joint replacement or reattachment of lower extremity with and without major complications or comorbidities (MS-DRG 469 and 470)

Exclusion criteria

MSA exclusion criteria:
MSAs with low volume of LEJR
MSAs with high take-up of BPCI
MSAs with large share of LEJR in Maryland hospitals
Hospital exclusion criteria:
Hospitals participating in certain models of BPCI.
Patient exclusion criteria (the episode is cancelled if any of the following occurs during the episode):
Patient not covered by both Medicare Parts A and B
Patient eligibility for Medicare is due to end stage renal disease (ESRD)
Patient is in a managed care plan
Patient is in a United Mine Workers of America Plan
Medicare is not the primary payer for the patient
Patient dies during the episode
Patient is re-admitted to an ACH for one of the two CJR DRGs during the episode
Patient initiates an LEJR episode under BPCI during the episode
Payments and services that occur in the episode that are excluded are:
hemophilia clotting factors
new technology add-on payments
transitional pass-through payment for medical devices
payments from certain incentive programs
otherwise included payments that exceed two standard deviations of the regional mean
services unrelated to the index admission as defined by CMS (including certain inpatient hospital stays, Part B services, and per beneficiary per month (PBPM) payments).