{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:53:30Z","timestamp":1791428010405,"version":"4.3.3"},"reference-count":60,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,8,11]],"date-time":"2024-08-11T00:00:00Z","timestamp":1723334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL171859"],"award-info":[{"award-number":["K23HL171859"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["R01\u2010MD013859"],"award-info":[{"award-number":["R01\u2010MD013859"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01\u2010HS027595"],"award-info":[{"award-number":["R01\u2010HS027595"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Study Setting<\/jats:title><jats:p>We used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We conducted a retrospective observational study using a differences\u2010in\u2010differences method to compare changes in outcome disparities between dual\u2010eligible and non\u2010dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program. The primary outcome was LEJR complications. Secondary outcomes included 90\u2010day readmissions and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Extraction Methods<\/jats:title><jats:p>We identified hospitals in the US market areas eligible for CJR. We included beneficiaries in the intervention group who received joint replacement at hospitals in markets randomized to participate in CJR. The comparison group included patients who received joint replacement at hospitals in markets who were eligible for CJR but randomized to control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>The study included 1,603,555 Medicare beneficiaries (mean age, 74.6\u2009years, 64.3% women, 11.0% dual\u2010eligible). Among participant hospitals, complications decreased between baseline and intervention periods from 11.0% to 10.1% for dual\u2010eligible and 7.0% to 6.4% for non\u2010dual\u2010eligible beneficiaries. Among nonparticipant hospitals, complications decreased from 10.3% to 9.8% for dual\u2010eligible and 6.7% to 6.0% for non\u2010dual\u2010eligible beneficiaries. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual\u2010eligible and non\u2010dual\u2010eligible beneficiaries (\u22120.9 percentage points, 95% CI \u22121.6 to \u22120.1). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model. There were no differential changes in 90\u2010day readmissions or mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Mandatory participation in a bundled payment program was associated with reduced disparities in joint replacement complications for Medicare beneficiaries with low income. To our knowledge, this is the first evidence of reduced socioeconomic disparities in outcomes under value\u2010based payments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14369","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T02:43:49Z","timestamp":1723430629000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3141-1772","authenticated-orcid":false,"given":"Austin S.","family":"Kilaru","sequence":"first","affiliation":[{"name":"The Parity Center, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of 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