Department of Orthopaedics, University of North Carolina Health Care, Durham, North Carolina.
J Arthroplasty. 2018 Sep;33(9):2722-2727. doi: 10.1016/j.arth.2018.04.006. Epub 2018 Apr 19.
Bundled payments are meant to reduce costs and improve quality of care. Without adequate risk adjustment, bundling may be inequitable to providers and restrict access for certain patients. This study examines patient factors that could improve risk stratification for the Comprehensive Care for Joint Replacement (CJR) bundled-payment program.
Ninety-five thousand twenty-four patients meeting the CJR criteria were retrospectively reviewed using administrative Medicare data. Multivariable regression was used to identify associations between patient factors and traditional (fee-for-service) Medicare reimbursement over the bundle period.
Average reimbursement was $18,786 ± $12,386. Older age, male gender, cases performed for hip fractures, and most comorbidities were associated with higher reimbursement (P < .05), except dementia (lower reimbursement; P < .01). Stratification incorporating these factors displayed greater accuracy than the current CJR risk adjustment methods (R = 0.23 vs 0.17).
More robust risk stratification could provide more equitable reimbursement in the CJR program.
Large database analysis; Level III.
捆绑支付旨在降低成本并提高医疗服务质量。如果没有充分的风险调整，捆绑支付可能对提供者不公平，并限制某些患者的获得途径。本研究旨在探讨可能改善综合关节置换捆绑支付计划（CJR）风险分层的患者因素。
使用医疗保险行政数据对符合 CJR 标准的 95024 例患者进行回顾性分析。采用多变量回归分析确定患者因素与捆绑期内传统（按服务收费）医疗保险报销之间的关联。
平均报销金额为 18786 美元±12386 美元。年龄较大、男性、髋部骨折手术和大多数合并症与更高的报销金额相关（P<0.05），除痴呆症（报销金额较低；P<0.01）外。纳入这些因素的分层显示出比当前 CJR 风险调整方法更高的准确性（R=0.23 比 0.17）。
更强大的风险分层可以为 CJR 计划提供更公平的报销。
大型数据库分析；III 级。
