Oncology Patients Are High Cost Outliers in Total Joint Replacement Bundled Payment Systems

• Published in: The Journal of arthroplasty 2020-01, Vol.35 (1), p.12-16.e1
• Main Authors: Woelber, Erik, Gundle, Kenneth R., Geddes, Jonah, Schabel, Kathryn L., Hayden, James B., Hasan, Saifullah R., Raymond, Lauren M., Doung, Yee-Cheen
• Format: Article
• Language: English
• Subjects: arthroplasty; bundled payments; cost control; costs; joint replacement; total hip
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2019.08.030

In 2016, the Centers for Medicare and Medicaid Services began its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, which covers a 90-day episode of care. This study determined whether oncology patients enrolled in the CJR bundle incur higher hospital costs than patients with osteoarthritis (OA). A retrospective review of all patients enrolled in the CJR bundled payments system from April 1, 2016 to June 31, 2018 at a single academic medical center was conducted. To determine whether tumor patients had higher total episode costs, this group was compared to patients diagnosed with OA using a 2-tailed t-test. To adjust for moderators of total hospital costs, we used generalized linear regression with a log-link, including multiple variables abstracted from chart review. Three hundred fourteen patients met inclusion criteria (12 primary or metastatic tumors, 302 OA). Fifty-eight percent of tumor patients were over the target price vs 16% of OA patients. The mean tumor patient had $40,862 for total internal hospital costs compared to $16,356 in the OA group (P