Medicare payment reforms for joint replacement didn't increase disparities in use between patients with Alzheimer's and those without, according to a new study in JAMA Health Forum on the first two years of program data.
The findings, published Friday, came after previous studies found the value-based payment reform was associated with a decrease in knee replacements for Black beneficiaries and dual-eligible beneficiaries. The relatively equitable treatment for Alzheimer's patients under the reformed model is encouraging, but policymakers should keep evaluating new models to make sure they're offering equitable care to vulnerable populations, the study's authors wrote.
Hip and knee replacements are the most common inpatient surgical procedures for Medicare beneficiaries, which makes them a natural target for the Center for Medicare and Medicaid Innovation's payment reforms.
One such program, the Comprehensive Care for Joint Replacement model, bundles payment for a joint replacement as a way to control the costs of these procedures and improve their quality. The model, which began in 2016 and stretches until 2024, proved in at least its first two years to lower joint replacement costs without compromising quality across the general Medicare population.
But prior studies have found the model widened gaps in knee replacement rates between white and Black Medicare beneficiaries, and contributed to socioeconomic disparities.
This prompted a look into the model's impact on Alzheimer's patients, led by Caroline Thirukumaran, an assistant professor at the University of Rochester Medical Center who conducted a previous study on the model's impact on Black and dual-eligible patients. Thirukamaran and her co-investigators hypothesized that the model could increase disparities for beneficiaries with Alzheimer's as well.