Association between bundled payments and quality outcomes

Editor's Note

In the first 21 months of the Bundled Payments for Care Improvement (BPCI) initiative for total hips and knees, Medicare payments declined more for BPCI participating hospitals than nonparticipating hospitals, without a significant change in quality outcomes, this study finds.

For the analysis, 31,700 total joints at 176 BPCI participating hospitals were matched with total joints at comparison hospitals.

The BPCI mean Medicare payments were $30,551 at baseline and declined by $3,286 in the intervention period. Comparison mean Medicare payments were $30,057 at baseline and declined by $2,119.

The larger decline in payments for the BPCI patients was primarily because of reduced use of institutional postacute care. There were no statistical differences in quality measures.

This study evaluates whether the Bundled Payments for Care Improvement initiative of the Centers for Medicare & Medicaid Services was associated with a greater reduction in Medicare payments without loss of quality of care for patients with lower extremity joint replacement.