Participating in quality improvement efforts will lower costs too, right? Maybe not. Research on hip and knee replacements for Medicare beneficiaries in 15 geographic markets indicates that hospitals taking part in intensive quality improvement programs may not have different outcomes. (Med. Care Article) Medicare has rolled out bundled payments for the episodes surrounding these joint replacement procedures. Some of the hospitals in these 15 markets participated in something called the High Value Healthcare Collaborative that involved a variety of quality improvement activities. The performance of these hospitals was compared with similar hospitals in the same geographic markets but which did not participate in the HVHC program. Before the intervention there was substantial variation across the geographic markets in post-acute care related to these episodes and much less variation between hospitals within a particular geographic market. There was also substantial variation across hospitals in procedure volume and in acute length of stay.
There was much less difference between the HVHC hospitals and the comparison hospitals in post-acute spending than there was between geographic markets. After adjusting for patient characteristics, there was no difference between the two groups of hospitals in either acute length of stay or post-acute care spending. The study confirms that most of the difference in total episode spending is due to post-acute care. But the results strongly suggest that geographic practice pattern factors are responsible for almost all the variation in post-acute care spending, and that quality improvement efforts do little to lessen that variation. Another bubble burst.