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Research Studies is a compilation of published research articles funded by 大象APPor authored by 大象APPresearchers.

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1 to 9 of 9 Research Studies Displayed
Kilaru AS, Liao JM, Wang E
Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.
This study鈥檚 objective was to determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. The authors used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. They conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program, with the primary outcome LEJR complications. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model, and there were no differential changes in 90-day readmissions or mortality.
AHRQ-funded; HS027595.
Citation: Kilaru AS, Liao JM, Wang E . Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes. Health Serv Res 2024 Oct; 59(5):e14369. doi: 10.1111/1475-6773.14369..
Keywords: Disparities, Orthopedics, Surgery, Payment, Outcomes, Social Determinants of Health
Kim N, Jacobson M
Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement.
The objective of this cohort study was to evaluate outcomes associated with the Comprehensive Care for Joint Replacement (CJR) model--a traditional Medicare bundled payment program for lower-extremity joint replacement--among Hispanic patients who were not enrolled in traditional Medicare. Three metropolitan statistical areas (MSAs) were randomly selected in California to participate in CJR. The results indicated that CJR program outcomes differed by race and ethnicity for patients outside traditional Medicare. The authors noted that these findings suggested the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.
AHRQ-funded; HS026488.
Citation: Kim N, Jacobson M . Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement. JAMA Netw Open 2024 Sep 3; 7(9):e2433962. doi: 10.1001/jamanetworkopen.2024.33962..
Keywords: Medicare, Payment, Surgery, Orthopedics, Racial and Ethnic Minorities
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE . How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care? Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y . Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements. JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Machta RM, Reschovsky J, Jones DJ
大象APPAuthor: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ鈥檚 Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ . Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model? Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined 鈥渟urprise鈥 out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ . "Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources. Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Finch DJ, Pellegrini VD, Franklin PD
The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes.
This study compared outcomes for patients undergoing hip and knee arthroplasty at hospitals participating in Medicare鈥檚 bundled payment programs with hospitals that do not. They performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee replacement trial. Differences through 6 months were observed. Outcomes were described using the brief Knee Injury and Osteoarthritis Outcomes Score or the brief Hip Disability and Osteoarthritis Outcomes Score, the Patient-Reported Outcomes Measurement Information System Physical Health Score, and the Numeric Pain Rating Scale. While there slightly lower improvement at nonbundled hospitals at first, overall the effects were small.
Citation: Finch DJ, Pellegrini VD, Franklin PD . The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes. J Arthroplasty 2020 Apr;35(4):918-25.e7. doi: 10.1016/j.arth.2019.11.028..
Keywords: Orthopedics, Surgery, Payment
Chhabra KR, Ibrahim AM, Thumma JR
Impact of Medicare readmissions penalties on targeted surgical conditions.
The authors used Medicare claims to evaluate the effects of the 2013 expansion of the Hospital Readmissions Reduction Program on risk-adjusted readmission rates, episode payments, lengths-of-stay, and observation status use for hip and knee replacement surgery. They found that medical readmission penalties led to readmission reductions for surgical patients, that targeted surgical penalties did not have an additional effect, and that readmission reductions are approaching a point below which further reductions may be unlikely.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Ibrahim AM, Thumma JR . Impact of Medicare readmissions penalties on targeted surgical conditions. Health Aff 2019 Jul;38(7):1207-15. doi: 10.1377/hlthaff.2019.00096..
Keywords: Surgery, Hospital Readmissions, Orthopedics, Payment
Ellimoottil C, Ryan AM, Hou H
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Using Medicare claims for patients in Michigan who underwent lower extremity joint replacement in the period 2011-13, the researchers applied payment methods analogous to those CMS intends to use in determining annual bonuses or penalties (reconciliation payments) to hospitals. Their findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H . Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients. Health Aff 2016 Sep;35(9):1651-7. doi: 10.1377/hlthaff.2016.0263.
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Keywords: Medicare, Payment, Healthcare Costs, Orthopedics, Provider Performance

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