Joint replacement

Medicare’s Comprehensive Care for Joint Replacement Model has scored small savings for hospitals and their patients through decreasing the use of skilled nursing facility services, a new report finds.

Harvard researchers found that the Centers for Medicare & Medicaid Services, on average, saved about 3.1% per joint-replacement procedure, or $812, according to results published Wednesday in the New England Journal of Medicine. Savings were derived almost exclusively from reductions in post-procedure use of SNFs, researchers noted. Instead, more patients have been sent home.

Interest in bundled payment has “exploded” in recent years the study authors noted, meaning this trend could continue.

“The big question has always been whether this new model can lead hospitals to meaningfully reduce spending without harming patients,” Michael Barnett, M.D., lead author and assistant professor of health policy and management at Harvard Chan School, said in an announcement. “This study indicates that with the right financial incentive, hospitals can save money without compromising quality by sending more patients home rather than to a nursing facility.”

Bundled hospitals saved about 3% per patient before accounting for admin costs, bonuses and penalties.

There was little impact on how many higher-risk patients received lower extremity joint replacements, and the bundled model did not show effects on complication rates among patients, researchers added.

Study results were based on an analysis of data from more than 280,000 joint replacement procedures that were part of the program, across 800 hospitals from the first two years of CCJRM. They compared those costs to another nearly 378,000 procedures in more than 960 hospitals that weren’t a part of the experiment.