A new study published in JAMA examines the cost of joint replacement bundled payments.
The researchers examined 3,942 patients who underwent joint replacement at Baptist Health System, which participated in CMS's Acute Care Episodes and Bundled Payments for Care Improvement. The patients were all Medicare Advantage patients and underwent surgery from July 2008 to June 2015.
The researchers found:
1. The expenditures dropped 20.8 percent for 3,738 episodes of care that didn't have complications, decreasing from $26,785 in July 2008 to $21,208 in June 2015.
2. Expenditures for patients with complications decreased 13.8 percent from $38,537 in July 2008 to $33,216 in June 2015.
3. There was a 1.4 percent decline in readmissions over the study period and 0.9 percent decline in emergency department visits.
4. The episodes with prolonged length of stay dropped 67 percent during the study period while patient illness severity was stable.
5. More than half — 51.2 percent — of the overall hospital savings came from internal cost reductions and 48.8 percent came from postacute care spending reduction.
6. Implant costs dropped 29 percent per case over the study period, down $1,920.68 on average, which was a driver of the hospital savings.
7. The PAC spending declined by an average of $2,443.12 per case, 27 percent. The health system decreased inpatient rehabilitation and skilled nursing facility use, whichdrove the spending drop when bundles included financial responsibility for postacute care.
8. Medicare payments for joint replacements increased 5 percent over the study period. Postacute care spending decreased only when the patient participated in the bundle.
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