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Objective: To investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model over 2016-2020 and to identify the contributors to SNHs' realization of success under the program. Data Sources/Study Setting: Secondary data on all CJR hospitals were collected from the Centers for Medicare and Medicaid Services (CMS) public use files and from the American Hospital Association. Study Design: We addressed whether SNHs can achieve progress in financial performance under CJR by focusing on the relative change in reconciliation payments or the difference between episode spending and target prices. We applied the method of dominance analysis to ordinary least squares regression to determine the relative importance of predictors of change in reconciliation payments over time. Principal Findings: Compared to CJR hospitals overall, SNHs were less successful in meeting episode spending targets. Hospital factors dominated socioeconomic factors in explaining progress among SNHs, but not among non-SNHs. The contribution of nurse staffing was negligible across all CJR hospitals. Conclusions: The formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performance under mandatory bundled payment. KEYWORDS health policy/politics/law/regulation, hospitals, Medicare, social determinants of health, uninsured/safety-net providers What is known on this topic * Hospitals that disproportionately serve Medicare beneficiaries with social risk factors often perform worse under value-based purchasing. * Safety-net hospitals historically have been exposed to greater financial risk than other hospitals. * Safety-net hospitals received lower financial rewards during the first two years of Medicare's mandatory Comprehensive Care for Joint Replacement (CJR) program. What this study adds * Safety-net hospitals were far less successful in spending performance progress over the first five years of CJR. * Under CJR, hospital factors dominated area socioeconomic factors in contributing to spending performance progress in SNHs but not in other hospitals., 1 | INTRODUCTION The Centers for Medicare and Medicaid Services (CMS) is expanding the use of value-based purchasing (VBP) models for Medicare payments to hospitals. A key mechanism is bundled [...]

Researchers say the largest-ever study of general practice in Aotearoa New Zealand sheds new light and creates a powerhouse of data for decision-making. A study into general practice models in [...]

2023 APR 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on antimicrobials and healthcare epidemiology is now available. According [...]