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Health Aff (Millwood). 2018 Jun;37(6):854-863. doi: 10.1377/hlthaff.2017.1358.

Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs.

Author information

1
Amol S. Navathe ( amol@pennmedicine.upenn.edu ) is an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
2
Joshua M. Liao is an assistant professor in the Department of Medicine at the University of Washington School of Medicine, in Seattle.
3
Daniel Polsky is the Robert D. Eilers Professor in Health Care Management and Economics and executive director of the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.
4
Yash Shah is a research assistant in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
5
Qian Huang is a statistical analyst in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
6
Jingsan Zhu is assistant director of data analytics in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
7
Zoe M. Lyon is a senior research coordinator, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.
8
Robin Wang is an undergraduate student in the College of Arts and Sciences, Cornell University, in Ithaca, New York.
9
Josh Rolnick is an associate fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.
10
Joseph R. Martinez is an MD-PhD student in the Perelman School of Medicine, University of Pennsylvania.
11
Ezekiel J. Emanuel is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania.

Abstract

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare's voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.

KEYWORDS:

Financing Health Care; Health Reform; Hospitals; Medicare; Organization and Delivery of Care

PMID:
29863929
DOI:
10.1377/hlthaff.2017.1358
[Indexed for MEDLINE]

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