CMS' bundled payment program for joint replacements hasn't limited sicker patients' access to hip and knee replacements, according to a Feb. 19 study in The Journal of Bone & Joint Surgery.
Five takeaways:
1. When CMS launched the Comprehensive Care for Joint Replacement program in 2016, some providers expressed concern that bundled payments would lead hospitals to "cherry pick" healthier patients while avoiding sicker patients, minority patients and patients of lower socioeconomic status.
2. To determine whether these concerns were realized, researchers evaluated patient characteristics in a sample of Medicare claims from 2015-16, which included more than 12,000 hip and knee replacements and follow-up care episodes in areas with bundled payment programs, as well as 20,000 episodes in other areas.
3. After adjusting for age and sex, researchers found no significant differences in the characteristics of hip and knee replacement patients who were treated in bundled payment areas and those treated in areas where reimbursement didn't change.
4. Surgeons may prefer to perform partial rather than total hip replacement on less-healthy patients to avoid treating these patients under a bundled payment program, the research suggested. However, there wasn't a difference in the numbers of black or low-income patients selected for partial hip replacements.
5. The study's limitations included reliance on claims data and a relatively short follow-up period. The researchers cited a need for further studies.
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