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Research Letter
October 2, 2019

Association Between Medicare’s Mandatory Joint Replacement Bundled Payment Program and Post–Acute Care Use in Medicare Advantage

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 3Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Surg. Published online October 2, 2019. doi:10.1001/jamasurg.2019.3957

Under bundled payment programs, such as Medicare’s Comprehensive Care for Joint Replacement (CJR) model, hospitals bear financial risk for posthospitalization care for beneficiaries in traditional fee-for-service Medicare. It is unknown whether participating hospitals change care patterns only for patients subject to the payment bundle or if changes spillover onto care for other patients undergoing joint replacement. Spillovers to Medicare Advantage (MA) patients would indicate that clinicians have a consistent approach to discharge planning regardless of payor1,2 and would suggest Medicare’s payment reforms have had a broader societal effect.3

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