Payment program linked to reduced joint replacement spending
medwireNews: Implementation of a bundled-payment program has led to a “modest reduction” in spending on knee and hip replacement operations in the USA, say researchers.
As reported in The New England Journal of Medicine, average institutional spending per knee or hip replacement operation decreased from US$ 25,903 (€ 22,809) before implementation of the program to $ 23,915 (€ 21,059) after 2 years of bundled payments among 803 hospitals that were randomly assigned to participate in the mandatory bundled-payment initiative. By comparison, spending decreased from an average of $ 24,596 (€ 21,656) to $ 23,238 (€ 20,461) per procedure in 962 control hospitals without bundled payments, giving an adjusted between-group difference of $ 812 (€ 715).
Michael Barnett (Harvard TH Chan School of Public Health, Boston, Massachusetts, USA) and study co-authors note that the differential decrease in spending was driven mainly by a 5.9% relative reduction in the proportion of patients discharged to post-acute care services, which they say “may be the easiest target for hospitals to decrease episode-level spending because it is often unclear when these services are beneficial.”
The rate of surgical complications was comparable among intervention and control hospitals, as was the proportion of procedures carried out in patients who were categorized as high-risk based on predicted overall spending.
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