JAMA published a study showing bundled payments yielded significant savings for patients undergoing joint replacement surgeries. Despite the savings, President-elect Donald Trump's pick to lead HHS, Rep. Tom Price, MD, has opposed the mandatory payment program, according to Kaiser Health News.
In the study, researchers analyzed 3,924 patients undergoing lower extremity joint replacement surgery at San Antonio, Texas-based Baptist Health System. The patients participated in CMS' voluntary Acute Care Episodes and Bundled Payments for Care Improvement demonstration projects.
The study found:
● The average Medicare episode expenditures fell 20.8 percent for 3,738 episodes of joint replacement without complications
● For 204 episodes with complications, Medicare episode expenditures, on average, fell 13.8 percent
● ACE and BPCI lowered readmission and emergency department visits by 1.4 percent
● Episodes with prolonged length of stay fell 67 percent
● Study researchers estimated if every hospital utilized this bundled payment model, Medicare could save $2 billion each year
Dr. Price wrote a letter in September 2016 saying Medicare has surpassed its power through mandating bundled payments, which the HHS pick said takes decision-making power away from providers and patients. However, study authors argue bundled payments enable teamwork between surgeons, administrators and patients as the program's success in lowering costs is contingent on physicians creating standardized pathways for care.
Dr. Price said the government should not make such programs mandatory. Darshak Sanghavi, PhD, former director of prevention and population health at the Center for Medicare and Medicaid Innovation, said voluntary programs will result in only those hospital that are currently delivering care efficiently to participate. Thus, making bundled payments mandatory will give lower-performing hospitals motivation to become more efficient. Dr. Sanghavi told KHN, "Stopping the programs for ideological reasons I think impedes innovation in a way that is going to consign us to having really, really high costs of care that's going to continue in the future."
In April 2016, CMS required nearly 800 hospitals in 67 cities to participate in bundled payment models for joint replacements and 90 days of care following the procedure. KHN reports if Republicans repeal the ACA, the mandatory bundled payment program will likely cease to exist.