Bundled payments could help address postsurgical disparities among minority patients

Female doctor talking to male patient in hospital bed
Black patients are more likely than white patients to be discharged to a post-acute care facility after joint replacement surgery. (Getty/monkeybusinessimages)

Postsurgical discharge disparities pose a significant clinical challenge, but the current spotlight on post-acute care outcomes could set the stage for addressing these issues, experts say. 

About 70% of patients who undergo joint replacement surgery are discharged home, while 30% are sent to a post-acute care facility, wrote Robert E. Burke, M.D., a hospitalist at the Denver VA Medical Center, and Said A. Ibrahim, M.D., professor of medicine at the University of Pennsylvania, in a JAMA Viewpoint article

Home healthcare is a less costly alternative to post-acute care.

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Black patients, meanwhile, are far more likely than white patients to be discharged to a post-acute care facility if they have a joint replacement, according to the article. More than half (55.2%) of black patients in 2015 were discharged to an institution, compared with 33.3% of white patients. 

Compounding the problem, according to Burke and Ibrahim, is that black patients are already less likely to have joint replacements when they need them. And black patients are more likely to live in neighborhoods with low-quality skilled nursing or other post-acute care, which could worsen their outcomes, according to the article. 

Payment reforms such as bundled payments offer a starting point for addressing these disparities, Burke and Ibrahim wrote. They call for more study on the specific needs of black patients along the continuum of care, and how these value-based care models can adapt to meet those needs.

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Gathering more information about patients at discharge to build evidence-based strategies for discharge planning is one option, they said, adding that "novel, enhanced forms of home support may need to be developed or adapted for vulnerable populations." 

Plans to publish readmission and community discharge rates for skilled nursing facilities can also be adapted to better serve minority patients, according to the article. Instead of focusing on eliminating disparities at the point of discharge, these data could instead be leveraged to encourage more black patients to get joint replacements and get them more involved in their care journeys. 

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