Status:

COMPLETED

The Impact of Medicare Bundled Payments

Lead Sponsor:

Amy Finkelstein

Collaborating Sponsors:

Harvard University

University of Chicago

Conditions:

Arthroplasty, Replacement

Eligibility:

All Genders

Phase:

NA

Brief Summary

Bundled payments (BP) are a key part of Medicare's shift away from the traditional fee-for-service (FFS) payment model. The investigators propose to study a nationwide randomized-controlled trial (RCT...

Eligibility Criteria

Inclusion

  • Acute care hospital paid under the inpatient prospective payment system (IPPS)
  • Hospital admission for major joint replacement or reattachment of lower extremity with and without major complications or comorbidities (MS-DRG 469 and 470)

Exclusion

  • MSA exclusion criteria:
  • MSAs with low volume of LEJR
  • MSAs with high take-up of BPCI
  • MSAs with large share of LEJR in Maryland hospitals
  • Hospital exclusion criteria:
  • Hospitals participating in certain models of BPCI.
  • Patient exclusion criteria (the episode is cancelled if any of the following occurs during the episode):
  • Patient not covered by both Medicare Parts A and B
  • Patient eligibility for Medicare is due to end stage renal disease (ESRD)
  • Patient is in a managed care plan
  • Patient is in a United Mine Workers of America Plan
  • Medicare is not the primary payer for the patient
  • Patient dies during the episode
  • Patient is re-admitted to an ACH for one of the two CJR DRGs during the episode
  • Patient initiates an LEJR episode under BPCI during the episode
  • Payments and services that occur in the episode that are excluded are:
  • hemophilia clotting factors
  • new technology add-on payments
  • transitional pass-through payment for medical devices
  • payments from certain incentive programs
  • otherwise included payments that exceed two standard deviations of the regional mean
  • services unrelated to the index admission as defined by CMS (including certain inpatient hospital stays, Part B services, and per beneficiary per month (PBPM) payments).

Key Trial Info

Start Date :

April 1 2016

Trial Type :

INTERVENTIONAL

Allocation :

ACTUAL

End Date :

February 1 2022

Estimated Enrollment :

196 Patients enrolled

Trial Details

Trial ID

NCT03407885

Start Date

April 1 2016

End Date

February 1 2022

Last Update

March 3 2022

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