Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty.

The Journal of Arthroplasty
Aakash H KeswaniCalin S Moucha

Abstract

Under bundled payment models, gainsharing presents an important mechanism to ensure engagement and reward innovation. We hypothesized that metric selection, metric targets, and risk adjustment would impact surgeons' performance in gainsharing models. Patients undergoing total joint arthroplasty at an urban health system from 2017 to September 2018 were included. Gainsharing metrics included the following: length of stay, % discharge-to-home, 90-day readmission rate, % of patients with episode spend under target price, and % of patients with patient-reported outcomes (PROs) collected. Four scenarios were created to evaluate how metric selection/adjustment impacted surgeons' performance designation: scenario 1 used "aspirational targets" (>60th percentile), scenario 2 used "acceptable targets" (>50th percentile), scenario 3 risk-adjusted surgeon performance prior to comparing aspirational targets, and scenario 4 included a PRO collection metric. Number of metrics achieved determined performance tier, with higher tiers getting a greater share of the gainsharing pool. In total, 2776 patients treated by 12 surgeons met inclusion criteria (mean length of stay 3.0 days, readmission rate 4.0%, discharge-to-home 74%, episode spend under...Continue Reading

References

Dec 4, 2008·Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation·Alfredo J SelimLewis E Kazis
Aug 19, 2010·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·I Michael LeitmanDavid J Shulkin
Sep 14, 2010·Health Services Research·Michael Chernew
Aug 7, 2012·Clinical Orthopaedics and Related Research·Hilal Maradit KremersDavid G Lewallen
Jan 3, 2013·Arthritis Care & Research·Ernest R VinaC Kent Kwoh
May 8, 2013·Clinical Orthopaedics and Related Research·Kevin J BozicMervyn Maze
Sep 21, 2013·Annals of the Rheumatic Diseases·Jasvinder A SinghPeter Cram
Sep 21, 2013·The Journal of Bone and Joint Surgery. American Volume·Kevin J BozicJames I Huddleston
Jul 24, 2015·Clinical Orthopaedics and Related Research·Jonathan L BerlinerKevin J Bozic
Oct 3, 2015·The Journal of Arthroplasty·Richard IorioJoseph D Zuckerman
Apr 14, 2016·The Journal of Arthroplasty·R Carter ClementLee A Fleisher
Jun 24, 2016·Clinical Orthopaedics and Related Research·Joseph Bernstein
Jul 1, 2016·Orthopedics·R Carter ClementLee Fleisher
Nov 22, 2016·Journal of Orthopaedic Trauma·Peter L Althausen, Lisa Mead
Dec 8, 2016·The Journal of Bone and Joint Surgery. American Volume·John M DundonRichard Iorio
Apr 4, 2017·The Journal of Arthroplasty·Afshin A Anoushiravani, Ryan M Nunley
Jun 21, 2017·The Journal of Arthroplasty·P Maxwell CourtneyBrett R Levine
Jul 6, 2017·The New England Journal of Medicine·Judith F Baumhauer
Sep 27, 2018·The Journal of the American Academy of Orthopaedic Surgeons·Joseph A BoscoRichard Iorio

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Citations

Mar 23, 2021·The Journal of the American Academy of Orthopaedic Surgeons·Kevin Y WangAmit Jain
Apr 27, 2021·Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association·Prakash JayakumarKevin J Bozic

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