Do Benefits from Joint Replacement Bundles "Spill Over" to benefit other patients?
In a recent article, VSSL Director Joshua Liao led a team that evaluated whether benefits from the Comprehensive Care for Joint Replacement (CJR) Model -- a mandatory Medicare fee-for-service model that requires hospitals in certain health care markets to accept bundled payments for joint replacement surgery -- “spilled over” to individuals insured through private health plans.
What they did: Dr. Liao and team used 2013–2017 Health Care Cost Institute claims for 418,016 privately insured individuals undergoing joint replacement in 75 CJR and 121 Non-CJR markets. They used advanced statistical methods -- multivariable generalized linear models with hospital and market random effects and time fixed effects -- to analyze the association between CJR participation and changes in outcomes.
What they found: The study team found that patients in CJR and Non-CJR markets did not differ in total episode spending (difference of -$157, 95% CI -$1043 to $728, p = 0.73), discharge to institutional post-acute care (difference of −1.1%, 95% CI -3.2%–1.0%, p = 0.31), or other outcomes.
The team concluded that "there was a lack of evidence of cost or utilization spillovers from CJR to privately insured individuals. There may be limits in the ability of certain value-based payment reforms to drive broad changes in care delivery and patient outcomes."