Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements

Published in: Health Services Research, Volume 53, Issue 6, pages 4381–4402 (December 2018). doi: 10.1111/1475-6773.13013

Posted on on January 21, 2021

by Caroline P. Thirukumaran, Laurent G. Glance, Meredith B. Rosenthal, Helena Temkin-Greener, Rishi Balkissoon, Addisu Mesfin, Yue Li


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.


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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