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Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements
Author(s) -
Thirukumaran Caroline P.,
Glance Laurent G.,
Rosenthal Meredith B.,
TemkinGreener Helena,
Balkissoon Rishi,
Mesfin Addisu,
Li Yue
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13013
Subject(s) - venous thromboembolism , medicine , knee replacement , physical therapy , intensive care medicine , surgery , arthroplasty , thrombosis
Objective To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism ( VTE ) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program. Data Sources State Inpatient Database for New York ( NY ) from 2005 to 2013. Study Design The primary outcome was an occurrence of VTE . Medicare Utilization Ratio ( MUR ), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity. We used hierarchical logistic regressions with difference‐in‐differences estimation to study the Program effects. Principal Findings A total of 98,729 hip replacement and 111,361 knee replacement stays were identified. For hip replacement, the Program was associated with significant reduction (Range: 44% to 53%) in VTE incidence among hospitals in MUR quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in VTE incidence only among quartile 2 hospitals. Conclusion Implementation of the Program was associated with a reduction in VTE , especially for hip replacements, in higher MUR hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.

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