Physician and Hospital Performance in Medicare’s Updated Bundled-Payment Model for Joint Replacement

Are physician and hospital participation in the Medicare Bundled Payments for Care Improvement Advanced (BPCI-A) associated with changes in health care spending, quality, and utilization for lower-extremity joint replacement?This cohort study including 846 529 Medicare beneficiaries found that treatment by physicians in BPCI-A−participating group practices was associated with an $855 differential reduction in spending at 90 days compared to nonparticipating practices. Likewise, treatment at BPCI-A−participating hospitals was associated with a $613 differential reduction.These findings suggest that physicians and hospitals may be effective at reducing spending in bundled payments, and that future models should consider strategies to align physicians when participation is restricted to hospitals.

Corresponding Author: Amol S. Navathe, MD, PhD, The Parity Center, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19146 (amol@pennmedicine.upenn.edu).

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