Study: Bundled payments cut readmissions and SNF use in joint replacement patients

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Implementing bundled payments for joint replacements reduced hospital readmissions and decreased discharges to post acute care facilities, according to new study results.

A three-year investigation of joint replacements at New York University's Langone Medical Center saw the average length of hospital stay for patients in the Bundled Payment for Care Improvement pilot drop from 3.58 days to 2.96 days. Hospital readmissions also decreased at the 30- , 60- and 90-day benchmarks, according to the study, which was released Wednesday.

Discharges to rehabilitation and care facilities fell from 44% to 28% over the course of the study, researchers found. The average Medicare costs for each bundled episode of care decreased from $34,249 in the first year of the program to $27,541 in the third year.

The announcement comes just weeks before the Center for Medicare & Medicaid Services' Comprehensive Care for Joint Replacement payment pilot goes into effect at hospitals in 67 geographic areas.

Long-term care providers have expressed concern that they're “locked out” of hospital-centric bundled payment models, which hold hospitals accountable for all financial risk surrounding the surgery, inpatient stay and care following discharge. Bundled payments may also put facilities with low ratings at risk, one expert warned, because hospitals might seek partnerships only with facilities that have proven track records of quality and financial outcomes.

Last month, the Kaiser Family Foundation released a report that found certain bundled payment models saved more money by discharging hospital patients to home, instead of skilled nursing facilities. Other models in CMS' BPCI pilot showed little change in overall post-acute spending.