Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Arthroplasty, Replacement, Hip/*adverse effects ; Arthroplasty, Replacement, Knee/*adverse effects ; Medicare/*economics ; Reimbursement Mechanisms/*economics ; Venous Thromboembolism/*epidemiology; Aged ; Arthroplasty, Replacement, Hip/methods ; Arthroplasty, Replacement, Knee/methods ; Female ; Hospitals ; Humans ; Insurance Coverage/economics ; Male ; Models, Statistical ; New York ; United States ; Venous Thromboembolism/etiology

Objective: To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program.
Data Sources: State Inpatient Database for New York (NY) from 2005 to 2013.
Study Design: The primary outcome was an occurrence of VTE. Medicare Utilization Ratio (MUR), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity. We used hierarchical logistic regressions with difference-in-differences estimation to study the Program effects.
Principal Findings: A total of 98,729 hip replacement and 111,361 knee replacement stays were identified. For hip replacement, the Program was associated with significant reduction (Range: 44% to 53%) in VTE incidence among hospitals in MUR quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in VTE incidence only among quartile 2 hospitals.
Conclusion: Implementation of the Program was associated with a reduction in VTE, especially for hip replacements, in higher MUR hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.
(© Health Research and Educational Trust.)

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Keywords: Nonpayment program; hip and knee replacements; venous thromboembolism

Date Created: 20180720 Date Completed: 20190314 Latest Revision: 20231004

20240105

PMC6232432

10.1111/1475-6773.13013

30022482