Impact of the Comprehensive Care for Joint Replacement Bundled Payment Model on Postoperative Utilization of Home Health and Outpatient Physical Therapy Services

IF 3.6 2区 医学 Q1 REHABILITATION Archives of physical medicine and rehabilitation Pub Date : 2024-09-01 DOI:10.1016/j.apmr.2024.04.012
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Abstract

Objective

To study the effect of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on postoperative home health and outpatient physical therapy (PT) for total hip or knee arthroplasty (THA/TKA).

Design

Retrospective cohort with national Medicare data (5% claims) using a difference-in-differences analysis comparing January 2013-September 2015 (before) versus October 2016-September 2019 (after).

Setting

Administrative claims from hospitals in 34 metropolitan statistical areas with mandatory CJR participation as of 2018 and 42 control metropolitan statistical areas.

Participants

Episodes in fee-for-service Medicare beneficiaries (5% claims) undergoing elective THA (n=6327) or TKA (n=10,764) with community discharge.

Interventions

Implementation of CJR bundled payment program.

Main Outcome Measures

Home health and outpatient PT, including any use and number of visits.

Results

Program implementation was associated with an increased percentage of THA episodes using home health PT (+8.0 percentage-point change; 95% CI, +3.5 to +12.6; P=.001) but a decreased per-episode number of home health PT visits for THA (−1.1; 95% CI, −1.6 to −0.6; P<.001) and TKA (−1.1; 95% CI, −1.4 to −0.7; P<.001). The program was also associated with an increased per-episode number of outpatient PT visits for TKA in the primary but not sensitivity analyses (+0.8; 95% CI, +0.1 to +1.4; P=.02).

Conclusions

Findings of increased home health PT may reflect an intentional shift in care from the inpatient postacute setting to the community to decrease costs. Alternatively, the limited effect of CJR, particularly on outpatient PT, could reflect challenges with care coordination in a retrospective bundle spanning multiple care settings.

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关节置换综合护理捆绑支付模式对术后利用家庭保健和门诊理疗服务的影响。
目的研究关节置换综合护理(CJR)捆绑支付计划对全髋关节或膝关节置换术(THA/TKA)术后家庭保健和门诊理疗(PT)的影响:设计:利用全国医疗保险数据(5% 的索赔)进行回顾性队列,采用差异分析法比较 2013 年 1 月至 2015 年 9 月(之前)与 2016 年 10 月至 2019 年 9 月(之后):截至 2018 年强制参与 CJR 的 34 个大都市统计区和 42 个对照大都市统计区医院的行政索赔:接受择期 THA(6327 人)或 TKA(10764 人)并在社区出院的付费医疗保险受益人(5% 的索赔)的事件:干预措施:实施 CJR 捆绑支付计划:干预措施:实施 CJR 捆绑支付计划:结果:该计划的实施与使用家庭医疗PT的THA病例百分比增加有关(+8.0个百分点的变化,95% CI +3.5至+12.6,P=0.001),但THA每病例家庭医疗PT就诊次数减少(-1.1,95% CI -1.6 至-0.6,P=0.001):居家医疗护理次数增加的结果可能反映了为降低成本而有意将护理从住院病人治疗后的环境转移到社区。另外,CJR 的影响有限,尤其是对门诊 PT 的影响有限,这可能反映了在跨越多个护理环境的回顾性捆绑中,护理协调所面临的挑战。
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来源期刊
CiteScore
6.20
自引率
4.70%
发文量
495
审稿时长
38 days
期刊介绍: The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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