Observational studyHealth services research2024
Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.
Observational study in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
5 citing papers in PubMed.
- Participants in Medicare's New Mandatory Bundled Payment Program.Population health management · 2026Article
- Impact of the Comprehensive Care for Joint Replacement Model on Spending and Care Endpoints: A Systematic Review.The Journal of arthroplasty · 2026Review
- Physician and Hospital Performance in Medicare's Updated Bundled-Payment Model for Joint Replacement.JAMA health forum · 2025Article
- Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.Health services research · 2024Observational
- Value-based care as a solution to resolve the open debate on public healthcare outsourcing in Europe: What do the available data say?Frontiers in public health · 2024Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectiveTo 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. DATA SOURCES AND STUDY
settingWe used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. STUDY
designWe 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. The primary outcome was LEJR complications. Secondary outcomes included 90-day readmissions and mortality. DATA EXTRACTION
methodsWe identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control. PRINCIPAL
findingsThe study included 1,603,555 Medicare beneficiaries (mean age, 74.6 years, 64.3% women, 11.0% dual-eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual-eligible and 7.0% to 6.4% for non-dual-eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual-eligible and 6.7% to 6.0% for non-dual-eligible beneficiaries. 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, 95% CI -1.6 to -0.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90-day readmissions or mortality.
conclusionsMandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medicare beneficiaries with low income. To our knowledge, this is the first evidence of reduced socioeconomic disparities in outcomes under value-based payments.
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