Hospitals in the Comprehensive Care for Joint Replacement Model reduced average Medicare payments for episodes of care by 3.3 percent or more while maintaining quality during the first performance year, according to an analysis conducted by the Lewin Group, a Falls Church, Va.-based healthcare consulting firm and subsidiary of Optum.
Data from the first performance year — April 2016 through December 2016 — shows average total episode payments for lower extremity joint replacements under the CJR program were at least $910 less than those in the control group. An episode of care in the CJR program starts with hospitalization for the surgery and ends 90 days after discharge. This reduction in payments was observed in both elective surgeries and unplanned surgeries due to fracture. It was also observed in geographic regions with historically high and historically low payments.
The program was mandatory in 67 metropolitan statistical areas. Meanwhile, hospitals were able to maintain the quality of care, measured by readmission rates, emergency department visits and mortality rates.
Hospitals largely reduced the cost of the episode by using less expensive post-acute care settings. Hospitals sent fewer patients to the more intensive post-acute care settings, such as inpatient rehabilitation facilities, and patients spent less time in skilled nursing facilities.
Read the full report here.
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