The Impact of Medicare Bundled Payments: Evidence From a Nationwide Randomized Evaluation for Lower Extremity Joint Replacement
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 196
- 主要终点
- Share of LEJR admissions discharged to institutional Post-Acute Care (PAC)
研究概览
简要总结
Bundled payments (BP) are a key part of Medicare's shift away from the traditional fee-for-service (FFS) payment model. The investigators propose to study a nationwide randomized-controlled trial (RCT) of bundled payments for knee and hip replacements that was designed and implemented by CMS and launched in April 2016. Randomization was conducted at the Metropolitan Statistical Area (MSA) level with 67 MSAs and about 800 hospitals assigned to the treatment group. The investigators will examine the impact of bundled payments on Medicare spending, utilization, and quality. Study findings should be directly relevant for the design of payments for knee and hip replacements, two common and expensive medical procedures. Average impacts, as well as variation in impact across types of providers and markets may also shed light on economic mechanisms, which should be relevant for bundled payment initiatives under consideration for other medical services.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Acute care hospital paid under the inpatient prospective payment system (IPPS)
- •Hospital admission for major joint replacement or reattachment of lower extremity with and without major complications or comorbidities (MS-DRG 469 and 470)
排除标准
- •MSA exclusion criteria:
- •MSAs with low volume of LEJR
- •MSAs with high take-up of BPCI
- •MSAs with large share of LEJR in Maryland hospitals
- •Hospital exclusion criteria:
- •Hospitals participating in certain models of BPCI.
- •Patient exclusion criteria (the episode is cancelled if any of the following occurs during the episode):
- •Patient not covered by both Medicare Parts A and B
- •Patient eligibility for Medicare is due to end stage renal disease (ESRD)
- •Patient is in a managed care plan
- •Patient is in a United Mine Workers of America Plan
- •Medicare is not the primary payer for the patient
- •Patient dies during the episode
- •Patient is re-admitted to an ACH for one of the two CJR DRGs during the episode
- •Patient initiates an LEJR episode under BPCI during the episode
- •Payments and services that occur in the episode that are excluded are:
- •hemophilia clotting factors
- •new technology add-on payments
- •transitional pass-through payment for medical devices
- •payments from certain incentive programs
- •otherwise included payments that exceed two standard deviations of the regional mean
- •services unrelated to the index admission as defined by CMS (including certain inpatient hospital stays, Part B services, and per beneficiary per month (PBPM) payments).
结局指标
主要结局
Share of LEJR admissions discharged to institutional Post-Acute Care (PAC)
时间窗: At hospital discharge up to 3 days
Share of lower extremity joint replacement (LEJR) index admissions discharged to institutional post-acute care facilities (i.e. skilled nursing facilities (SNF), long term care hospitals (LTCH) or inpatient rehabilitation facilities (IRF)). LEJR index admissions are eligible admissions at acute care hospitals (ACH) that result in a discharge in either DRG 469 or 470.
次要结局
- Number of days in Institutional PAC during episode(Begins with index admission and ends 90 days post-discharge from index admission)
- Total covered Medicare payments for Institutional PAC during episode(Begins with index admission and ends 90 days post-discharge from index admission)
- Total covered Medicare payments for any PAC during episode(Begins with index admission and ends 90 days post-discharge from index admission)
- Total beneficiary payments owed out of pocket during episode(Begins with index admission and ends 90 days post-discharge from index admission)
- Share of LEJR admissions discharged to any Post Acute Care (PAC)(At hospital discharge up to 3 days)
- Total covered Medicare payments during episode(Begins with index admission and ends 90 days post-discharge from index admission)
研究者
Amy Finkelstein
Scientific Director, J-PAL North America
Abdul Latif Jameel Poverty Action Lab