To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism () following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program.
State Inpatient Database for New York () from 2005 to 2013.
The primary outcome was an occurrence of . Medicare Utilization Ratio (), 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.
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 incidence among hospitals in quartiles 2 to 4. For knee replacement, the Program was associated with significant reduction (47%) in incidence only among quartile 2 hospitals.
Implementation of the Program was associated with a reduction in , especially for hip replacements, in higher hospitals. Payment reforms such as Medicare's Nonpayment Program that withhold payments for complications are effective and should be continued.