LAUSR

Supplemental Digital Content is Available in the Text. Objectives: To study the impact of bundled payments for surgically managed hip fractures on care access, care quality, health care resource utilization, clinical impact, and acute care cost. Design: An observational retrospective cohort study using a quasi-experimental design comparing prebundled and postbundled payments through an interrupted time series analysis. Setting: A public acute care general hospital. Patients: Patients 60 years and older, with surgery for an isolated, unilateral, nonpathological hip fracture during 2014–first quarter of 2019 [diagnosis-related group codes: I03A, I03B, I08A, and I08B] and transferred to specific rehabilitation institutions were studied. Intervention: Bundled payments for funder-to-provider reimbursement. Main Outcomes Measurements: Care access, care quality, health care resource utilization, clinical impact, and cost. Results: Of 1477 patients, 811 were assigned to prebundled and 666 to postbundled payments. Although there was an improving trend of ward admission waiting times during postbundled payments [odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.02–1.28], ward admission waiting times were longer when compared with prebundled payments (OR = 0.45; 95% CI: 0.23–0.85). Rates of 30-day all-cause readmissions were lower (OR = 0.08; 95% CI: 0.01–0.67), and trends of reducing inpatient rehabilitation and overall episode length of stay (OR = 1.26; 95% CI: 1.16–1.37 and OR = 1.17; 95% CI: 1.07–1.28, respectively) were demonstrated during postbundled payments. Acute care cost for complex cases were higher (OR = 0.49; 95% CI: 0.26–0.92) during bundled payments, compared with prebundled payments. Conclusions: Bundled payments for surgically managed hip fractures were associated with benefits for several outcomes pertinent to clinical improvement initiatives. More work, especially concerning cost-effective surgical implants and better care cost computations, are critically needed to contain the growth of acute medical care cost for these patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.