Effect of Medicare’s bundled payment program on volume, case mix

Editor's Note

Hospital participation in Medicare’s Bundled Payments for Care Improvement (BPCI) program for lower extremity joint replacement (LEJR) was not associated with changes in overall procedural volume or the majority of patient case-mix factors, this study finds.

The analysis of 1,717,243 Medicare patients found hospital participation in the BPCI initiative was not significantly associated with a change in overall volume of LEJR episodes, estimated as a nonsignificant differential increase in episodes of 0.32%.

Participation also was not associated with changes in most case-mix factors, but it was associated with a small, statistically significant reduction of 0.53% in the likelihood of patients with prior skilled nursing facility use having LEJR.

The study findings may provide reassurance about two potential unintended effects of bundled payment for LEJR, the researchers say--having to increase overall volume, which could eliminate savings, or having to shift case mix to lower-risk patients.