Spending And Quality After Three Years Of Medicare's Voluntary Bundled Payment For Joint Replacement Surgery

Amol S Navathe; Ezekiel J Emanuel; Atheendar S Venkataramani; Qian Huang; Atul Gupta; Claire T Dinh; Eric Z Shan; Dylan Small; Norma B Coe; Erkuan Wang; Xinshuo Ma; Jingsan Zhu; Deborah S Cousins; Joshua M Liao

doi:10.1377/hlthaff.2019.00466

Spending And Quality After Three Years Of Medicare's Voluntary Bundled Payment For Joint Replacement Surgery

Health Aff (Millwood). 2020 Jan;39(1):58-66. doi: 10.1377/hlthaff.2019.00466.

Authors

Amol S Navathe¹, Ezekiel J Emanuel², Atheendar S Venkataramani³, Qian Huang⁴, Atul Gupta⁵, Claire T Dinh⁶, Eric Z Shan⁷, Dylan Small⁸, Norma B Coe⁹, Erkuan Wang¹⁰, Xinshuo Ma¹¹, Jingsan Zhu¹², Deborah S Cousins¹³, Joshua M Liao¹⁴

Affiliations

¹ Amol S. Navathe ( amol. navathe@gmail. com ) is a core investigator at the Corporal Michael J. Cresencz Veterans Affairs Medical Center, in Philadelphia, and an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and a senior fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
² 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.
³ Atheendar S. Venkataramani is an assistant professor of medical ethics and of health policy at the Perelman School of Medicine, University of Pennsylvania.
⁴ Qian Huang is a statistical analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁵ Atul Gupta is an assistant professor in the Department of Health Care Management, Wharton School, University of Pennsylvania.
⁶ Claire T. Dinh is a medical student at Harvard Medical School, in Boston, Massachusetts. She was a research coordinator in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, when this work was completed.
⁷ Eric Z. Shan is a research assistant in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
⁸ Dylan Small is a professor in the Department of Statistics, University of Pennsylvania.
⁹ Norma B. Coe is an associate professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
¹⁰ Erkuan Wang is a data analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
¹¹ Xinshuo Ma is a data analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
¹² Jingsan Zhu is associate director of data analytics in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
¹³ Deborah S. Cousins is a project manager in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
¹⁴ Joshua M. Liao is medical director of payment strategy, director of the Value and Systems Science Lab, and an assistant professor in the Department of Medicine, all at the University of Washington, in Seattle, and an adjunct senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.

PMID: 31905062
DOI: 10.1377/hlthaff.2019.00466

Abstract

Medicare has reinforced its commitment to voluntary bundled payment by building upon the Bundled Payments for Care Improvement (BPCI) initiative via an ongoing successor program, the BPCI Advanced Model. Although lower extremity joint replacement (LEJR) is the highest-volume episode in both BPCI and BPCI Advanced, there is a paucity of independent evidence about its long-term impact on outcomes and about whether improvements vary by timing of participation or arise from patient selection rather than changes in clinical practice. We found that over three years, compared to no participation, participation in BPCI was associated with a 1.6 percent differential decrease in average LEJR episode spending with no differential changes in quality, driven by early participants. Patient selection accounted for 27 percent of episode savings. Our findings have important policy implications in view of BPCI Advanced and its two participation waves.

Keywords: Bundled charges; Bundled payments for care improvement; Costs and spending; Ethics; Government programs and policies; Health policy; Hospital quality; Markets; Medicare; Physician assistants; Quality of care.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arthroplasty, Replacement, Hip / economics
Arthroplasty, Replacement, Hip / standards
Arthroplasty, Replacement, Knee / economics
Arthroplasty, Replacement, Knee / standards
Episode of Care
Female
Humans
Male
Medicare / economics*
Medicare / trends
Patient Care Bundles / economics
Patient Care Bundles / statistics & numerical data*
Patient Selection
Quality of Health Care*
United States