Bundled-payment program for hip and knee replacement has not led to 'cherry-picking' of patients

Bundled-payment program for hip and knee replacement has not led to 'cherry-picking' of patients

A pilot program introducing bundled payments for hip and knee replacement (HKR) in Medicare patients hasn't led hospitals to "cherry-pick" healthier patients at lower risk of complications, reports a study in the February 19, 2020 issue of The Journal of Bone & Joint Surgery . The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer. In the first year of the bundled-payment program, there was no decrease in access to HKR for sicker patients, racial/ethnic minorities, or others at a higher risk of complication or death, according to the new research by Casey Jo Humbyrd, MD, and colleagues of The Johns Hopkins University, Baltimore. No major change in access to hip and knee replacement In 2016, the Centers for Medicare & Medicaid Services introduced the Comprehensive Care for Joint Replacement program, mandating bundled payments for elective HKR in Medicare patients. Rolled out in 67 randomly selected metropolitan areas, the program involved the use of pre-determined pricing that covered physician and hospital fees and all related care, from hospital admission through 90 days after surgery. The program was designed to decrease costs and cost variability while increasing the quality of care for HKR. However, some physicians have expressed concern that bundled payments might lead hospitals to preferentially select healthier patients at lower risk of complications or death ("cherry-picking"). Similarly, hospitals might avoid patients with additional health problems (comorbidities) or other characteristics associated with increased risk of complications or death, including black race and lower socioeconomic status ("lemon-dropping"). Early program analyses showed cost savings, however, studies also demonstrated a trend toward the selection of healthier patients for HKR performed under the bundled system." Dr. Humbyrd and coauthors Using a sample of Medicare claims from 2015 to 2016, the researchers evaluated possible changes in patient characteristics after the start of the bundled payment program. The study included a matched set of more than 12,000 episodes of HKR and follow-up care for patients in areas where bundled payments were introduced and 20,000 episodes in other areas. Related Stories



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