Hospitals participating in the Medicare Bundled Payment for Care Improvement Program reduced spending for lower extremity joint replacements over three years by an average 1.6% more than hospitals that did not participate, with no change in quality, according to a study reported last week in Health Affairs. Patient selection accounted for 27% of the savings. The study compared changes in spending and outcomes for lower extremity joint replacement episodes and patient, hospital and market characteristics for BPCI and non-BPCI hospitals and markets between October 2013 and December 2016. The authors said the savings support Medicare’s decision to expand voluntary bundles through BPCI Advanced. A systemic review of 20 other studies on bundled payment published last week in Health Affairs also found that bundled payment maintains or improves quality while lowering costs for lower extremity joint replacement, but not for other conditions or procedures. The authors said the Centers for Medicare & Medicaid Services should continue to scale up the BPCI and Comprehensive Care for Joint Replacement programs for lower extremity joint replacement, but account for differences in patient characteristics and risk, and consider changes to certain episode design features.

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