Medicare’s Bundled Payment Program–Does it Change Hospital Volume or Case Mix?

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine Penn Leonard Davis Institute of Health Economics

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
Penn Leonard Davis Institute of Health Economics

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with reduced episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes covered by Medicare. This could potentially eliminate Medicare-related savings or prompt hospitals to shift case mix to lower-risk patients.

Among the Medicare beneficiaries who underwent LEJR, BPCI participation was not significantly associated with a change in market-level volume (difference-in-differences estimate . In non-BPCI markets, the mean quarterly market volume increased 3.8% from 3.8 episodes per 1000 beneficiaries before BPCI to 3.9 episodes per 1000 beneficiaries after BPCI was launched. In BPCI markets, the mean quarterly market volume increased 4.4% from 3.6 episodes per 1000 beneficiaries before BPCI to 3.8 episodes per 1000 beneficiaries after BPCI was launched.

The adjusted difference-in-differences estimate between the market types was 0.32%. Among 20 demographic, socioeconomic, clinical, and utilization factors, BPCI participation was associated with changes in hospital-level case mix for only one factor, prior skilled nursing facility use in BPCI vs. non-BPCI markets.  Continue reading

Number of Joint Replacements Drop in Rheumatoid Arthritis Patients 

MedicalResearch.com Interview with:

Hip Replacement NIH Image

Hip Replacement
NIH Image

Samuel Hawley | Research Assistant (NIHR PhD Project) |
Pharmaco- and Device Epidemiology Group |
Centre for Statistics in Medicine | NDORMS |
University of Oxford 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The aim was to disentangle some of the potential reasons for the recent decline in joint replacement rates among rheumatoid arthritis (RA) patients in the developed world.

The main findings from our UK patient-level analysis indicated that joint replacement rates were not significantly different for users of TNF inhibitors versus the patients who remained only on conventional synthetic DMARDS, however we did find that TNF inhibitor use amongst older RA patients was associated with a 40% reduction in hip replacement rates. Continue reading

African Americans Do Worse After Joint Replacements, But Only In Disadvantaged Neighborhoods

MedicalResearch.com Interview with:

Susan M. Goodman, MD Director of the Integrative Rheumatology and Orthopedics Center of Excellence Hospital for Special Surgery

Dr. Goodman

Susan M. Goodman, MD
Director of the Integrative Rheumatology and Orthopedics Center of Excellence
Hospital for Special Surgery 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have previously reported that African Americans who have poorer health outcomes, may be disproportionately impacted by community factors. For African Americans undergoing knee replacement, no difference in pain and function was seen compared to whites in communities with little poverty, while in poor communities, African Americans had poorer outcomes. We wondered if this was generally true or if this only applied to knee replacements.

We found similar results; African Americans in richer neighborhoods have comparable outcomes to whites, but as poverty increases- in this study measured as percent with Medicaid coverage- outcomes worsen in a step wise fashion.

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Men and Women Have Different Post-Op Risks After Joint Replacement

MedicalResearch.com Interview with:

Darwin Chen, MD Assistant Professor, Orthopaedics Icahn School of Medicine at Mount Sinai

Dr. Darwin Chen

Darwin Chen, MD
Assistant Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study?

Response: Total hip and knee replacement surgery are among the most commonly performed orthopaedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement.

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New Joint Implants Fail To Demonstrate Benefit Over Older Models

Marc Nieuwenhuijse MD Research fellow ICOR and FDA Weill Cornell Medical College New York CityMedicalResearch.com Interview with:
Marc Nieuwenhuijse MD
Research fellow ICOR and FDA
Weill Cornell Medical College New York City

 

Medical Research: Why did you decide to study this topic?

Dr. Nieuwenhuijse : The introduction of new orthopaedic implants and related technologies has been the focus of major scientific and policy discussions since the failures of articular surface replacement and large head size metal-on-metal articulations in total hip replacement were brought to light. However, scientists and policy makers seem to “run out of steam,” and the momentum for change generated by these recent high profile failures is waning. The consequences of uncontrolled device introduction worldwide may not be fully recognised by the scientific community and there is a high likelihood that current practice regarding device innovations will not change much. As such, there is a need to investigate whether the problems associated with the articular surface replacement and large head size metal-on-metal articulation are isolated events or if there is a systemic problem affecting the introduction of a much wider range of implantable devices.

In this study, we systematically evaluate the evidence concerning the introduction of five substantial, innovative, relatively recent, and already widely implemented device technologies used in major total joint replacement to determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare.

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Osteoarthritis: Total Hip, Knee Replacements Reduce Cardiovascular Risk

Bheeshma Ravi, MDMedicalResearch.com Interview with:
Bheeshma Ravi, MD
Orthopedic Surgery
University of Toronto Medical Center

 

MedicalResearch.com: What are the main findings of the study?

Dr. Ravi:  This study suggests that in persons with moderate-severe osteoarthritis of the hip or knee, total joint replacement is associated with a significant reduction in the risks for serious cardiovascular events.

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Total Hip Replacements: Failure rate of Cemented vs Uncemented

MedicalResearch.com Interview with:
Keijo T Mäkelä Associate professor
Department of Orthopaedics and Traumatology
Turku University Hospital, Rauhankatu
Turku, FI-20100, Finland

MedicalResearch.com: What are the main findings of the study?

Answer:
• The implant survival of cemented total hip replacement was higher
than that of uncemented total hip replacement in patients aged 65
years and older in our multinational register study with a
comprehensive patient population.
• The proportion of uncemented total hip replacement is rapidly
increasing in Nordic countries. The increased use of uncemented total
hip replacement group is not supported by these data.
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