Spillovers of Medicare’s Mandatory Bundled Payment for Joint Replacement into Other Patients

Hospitals under risk for their traditional fee-for service Medicare (TM) patients’ post-acute care use have responded by discharging less to institutional settings. Little is known about whether these changes have spilled-over onto other patients not covered under Medicare’s Alternative Payment Models. Using hospitals randomly mandated to participate in Medicare’s Comprehensive Care for Joint Replacement (CJR) model—an episode-based payment for TM beneficiaries undergoing Lower Extremity Joint Replacement (LEJR)—compared with hospitals randomly mandated to no payment changes, we evaluated whether other hospital admissions not under risk such as other orthopedic admissions or LEJR Medicare Advantage (MA) patients (who were not under risk) also experienced differential changes in institutional PAC use after the start of the CJR program.