Joint replacement bundled-payment model does not increase complication rates, study finds

Written by Shayna Korol | January 08, 2019 | Print  |

Since being implemented in 2016, Medicare's Comprehensive Care for Joint Replacement program has led to a modest decrease in spending per hip or knee replacement episode without increasing complication rates, according to a study in The New England Journal of Medicine.

CJR is a national mandatory bundled-payment model for hip and knee replacements in randomly selected metropolitan areas. Hospitals in these statistical areas receive bonuses or incur penalties based on Medicare spending per hip or knee replacement episode, which is defined as the hospitalization plus 90 days post-discharge.

Here are three things to know:

1. Study authors evaluated episodes in 75 metropolitan statistical areas randomly assigned to participate in the program and compared them with those in 121 control areas before and after the CJR model was implemented.

2. After the CJR model was initiated, there were greater decreases in institutional spending per joint replacement episode. This reduction was driven by a 5.9 percent decrease in episodes in which patients were discharged to post-acute care facilities.

3. The CJR program did not significantly affect the complication rates or percentage of joint replacement procedures performed in high-risk patients.

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