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Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries

IMPORTANCE: The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve the quality of hip or knee replacement among Medicare beneficiaries. Yet whether this model may exacerbate existing racial/ethnic disparities in access to the surgery is unclear. OBJECTIV...

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Autores principales: Kim, Hyunjee, Meath, Thomas H. A., Quiñones, Ana R., McConnell, K. John, Ibrahim, Said A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985721/
https://www.ncbi.nlm.nih.gov/pubmed/33749766
http://dx.doi.org/10.1001/jamanetworkopen.2021.1772
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author Kim, Hyunjee
Meath, Thomas H. A.
Quiñones, Ana R.
McConnell, K. John
Ibrahim, Said A.
author_facet Kim, Hyunjee
Meath, Thomas H. A.
Quiñones, Ana R.
McConnell, K. John
Ibrahim, Said A.
author_sort Kim, Hyunjee
collection PubMed
description IMPORTANCE: The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve the quality of hip or knee replacement among Medicare beneficiaries. Yet whether this model may exacerbate existing racial/ethnic disparities in access to the surgery is unclear. OBJECTIVE: To examine the association of the CJR model with the receipt of elective hip or knee replacement across White, Black, and Hispanic Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic Medicare beneficiaries undergoing elective joint replacement in 65 treatment (selected for CJR participation) and 101 control metropolitan statistical areas (MSAs). EXPOSURES: Starting in April 2016, hospitals in the treatment MSAs were required to participate in the CJR model and were accountable for expenditures occurring during patients’ hospitalization for hip or knee replacement and 90 days after the hospital discharge. MAIN OUTCOMES AND MEASURES: Beneficiary-level elective hip or knee replacement receipt in a given year. RESULTS: Among 17 243 304 patients, 9 839 996 (57%) were women; 2 107 425 (12%) were age 85 years or older. Of the final sample, 14 632 434 (85%) were White beneficiaries, 1 518 629 (9%) were Black beneficiaries, and 1 092 241 (6%) were Hispanic beneficiaries. The CJR model was associated with an increase of 1.6 elective hip or knee replacements per 1000 beneficiary-years for Hispanic beneficiaries (95% CI, 0.06-2.05) and a decrease of 0.64 replacements for Black beneficiaries (95% CI, −1.25 to −0.02). No evidence was found for any changes for White beneficiaries per 1000 beneficiary-years (0.04 replacements, 95% CI, −0.35 to 0.42 replacements). The Black-White difference in the rate of elective hip or knee replacement per 1000 beneficiary-years further widened by 0.68 replacements (−0.68, 95% CI, −1.20 to −0.15). CONCLUSIONS AND RELEVANCE: In this cohort study, the CJR model was associated with increased receipt of elective hip or knee replacement among Hispanic beneficiaries, decreased receipt among Black beneficiaries, and no change in receipt among White beneficiaries. The decreased receipt of elective hip or knee replacement among Black beneficiaries may suggest that value-based payment models, including the CJR model, could be monitored for unintended consequences. However, the lack of similar findings among Hispanic beneficiaries suggests that payment models may have differential impacts across racial/ethnic groups.
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spelling pubmed-79857212021-04-12 Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries Kim, Hyunjee Meath, Thomas H. A. Quiñones, Ana R. McConnell, K. John Ibrahim, Said A. JAMA Netw Open Original Investigation IMPORTANCE: The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve the quality of hip or knee replacement among Medicare beneficiaries. Yet whether this model may exacerbate existing racial/ethnic disparities in access to the surgery is unclear. OBJECTIVE: To examine the association of the CJR model with the receipt of elective hip or knee replacement across White, Black, and Hispanic Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic Medicare beneficiaries undergoing elective joint replacement in 65 treatment (selected for CJR participation) and 101 control metropolitan statistical areas (MSAs). EXPOSURES: Starting in April 2016, hospitals in the treatment MSAs were required to participate in the CJR model and were accountable for expenditures occurring during patients’ hospitalization for hip or knee replacement and 90 days after the hospital discharge. MAIN OUTCOMES AND MEASURES: Beneficiary-level elective hip or knee replacement receipt in a given year. RESULTS: Among 17 243 304 patients, 9 839 996 (57%) were women; 2 107 425 (12%) were age 85 years or older. Of the final sample, 14 632 434 (85%) were White beneficiaries, 1 518 629 (9%) were Black beneficiaries, and 1 092 241 (6%) were Hispanic beneficiaries. The CJR model was associated with an increase of 1.6 elective hip or knee replacements per 1000 beneficiary-years for Hispanic beneficiaries (95% CI, 0.06-2.05) and a decrease of 0.64 replacements for Black beneficiaries (95% CI, −1.25 to −0.02). No evidence was found for any changes for White beneficiaries per 1000 beneficiary-years (0.04 replacements, 95% CI, −0.35 to 0.42 replacements). The Black-White difference in the rate of elective hip or knee replacement per 1000 beneficiary-years further widened by 0.68 replacements (−0.68, 95% CI, −1.20 to −0.15). CONCLUSIONS AND RELEVANCE: In this cohort study, the CJR model was associated with increased receipt of elective hip or knee replacement among Hispanic beneficiaries, decreased receipt among Black beneficiaries, and no change in receipt among White beneficiaries. The decreased receipt of elective hip or knee replacement among Black beneficiaries may suggest that value-based payment models, including the CJR model, could be monitored for unintended consequences. However, the lack of similar findings among Hispanic beneficiaries suggests that payment models may have differential impacts across racial/ethnic groups. American Medical Association 2021-03-22 /pmc/articles/PMC7985721/ /pubmed/33749766 http://dx.doi.org/10.1001/jamanetworkopen.2021.1772 Text en Copyright 2021 Kim H et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Kim, Hyunjee
Meath, Thomas H. A.
Quiñones, Ana R.
McConnell, K. John
Ibrahim, Said A.
Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title_full Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title_fullStr Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title_full_unstemmed Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title_short Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries
title_sort association of medicare mandatory bundled payment program with the receipt of elective hip and knee replacement in white, black, and hispanic beneficiaries
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985721/
https://www.ncbi.nlm.nih.gov/pubmed/33749766
http://dx.doi.org/10.1001/jamanetworkopen.2021.1772
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