Medicare payment reforms for joint replacement did not increase the disparity in usage between patients with and without Alzheimer’s disease, according to a new study by the JAMA Health Forum based on data from the program’s first two years.
The findings, released Friday, come after previous research showed cost-based pay reform was associated with fewer knee replacements for black and dual-entitlement beneficiaries. The relatively fair treatment of Alzheimer’s patients in the reformed model is encouraging, but policy makers must continue to evaluate new models to ensure they offer fair care to vulnerable populations, the study authors write.
Hip and knee replacements are the most common inpatient surgical procedure for Medicare recipients, making them a natural target for Center for Medicare payment reforms and Medicaid innovations.
One such program, the Joint Replacement Comprehensive Care Model, integrates joint replacement payments as a way to control the cost of these procedures and improve their quality. The model, which started in 2016 and runs until 2024, proved for at least the first two years, to reduce the cost of joint replacement without compromising quality in the general Medicare population.
But previous studies found that the model widened the gap in knee replacement rates between white and black Medicare recipients and contributed to socioeconomic inequality.
This prompted a study of the model’s impact on Alzheimer’s patients under the direction of Caroline Thirukumaran, an assistant professor at the University of Rochester Medical Center, who conducted a previous study on the model’s impact on blacks and dual-entitlement patients. Tirukamaran and her co-researchers suggested that this model could increase inequality among beneficiaries with Alzheimer’s disease as well.
By 2025, Alzheimer’s disease – the most common cause of dementia – is projected to affect 7.2 million people, up nearly 16% from 2021. report from the Alzheimer’s Association. The association estimates that dementia will cost Medicare $181 billion in 2021.
Patients with Alzheimer’s experience cognitive and physical deterioration, so they typically require more expensive inpatient post-acute joint replacement care—one area where service providers have cut costs in this model, the study says. It has also been shown that beneficiaries with Alzheimer’s disease have a higher rate of mortality and complications.
However, the researchers found that in the two years after the payment reform went into effect, the replacement gap between beneficiaries with and without Alzheimer’s disease did not widen significantly.
There is some evidence that beneficiaries newly diagnosed with Alzheimer’s disease received fewer knee replacements than they would have received outside the new model, but these findings warrant further research, the authors say.
“Given these mechanisms, our conclusion that the CJR model did not result in a disproportionate deterioration in the use of joint replacement for beneficiaries with [Alzheimer’s and related dementias] reassuring,” the study says.
Dr. Adam Rana, a Maine orthopedic surgeon and chairman of the board of directors of the American Association of Hip and Knee Surgeons, said the pay reform has enabled surgeons to better identify the risks of complications in vulnerable patients before surgery and then take action to address them.
“I think one thing that is reassuring that with value based care models is that we are still supporting access for higher risk groups because we place more value on pre-op work and optimization that is ongoing. to maintain access. caring for people,” he said.
However, the findings contribute to a growing call for Medicare and Medicaid service centers to better adapt value-based care models to account for social risks. Suppliers caring for vulnerable populations may require more or different resources to achieve the same performance standards as their counterparts caring for more affluent groups. Conversely, some say it could lead to a two-tier system of care in which providers to less well-off groups can get away with providing worse care, Dana Gelb Safran and Jonathan Jaffery, members of the Medicare Payments Advisory Panel, wrote in their report. Health Issues article Last spring.
The Comprehensive Joint Replacement Care model now adjusts for social risk factors, including condition hierarchical category, age, and dual eligibility. The researchers write that this may partially mitigate the overall model-related decline in hip replacements and the decline in knee replacements in patients with newly diagnosed Alzheimer’s disease. But stakeholders need to pay more attention to other vulnerable populations and how they are coping with cost-based pay reforms.
“Despite good intentions, these reforms may inadvertently limit care to vulnerable groups of patients…constant monitoring of these reforms ensures that beneficiaries with [Alzheimer’s] and other vulnerable patients receive fair and effective care,” the study says.