Established in 2016 as a mandatory bundled payment program, Medicare’s Comprehensive Care for Joint Replacement model aims to reduce health care costs and improve overall quality of care for knee and hip replacement procedures. The program rewards, or penalizes, hospitals on the basis of meeting health care spending benchmarks that do not account for vulnerable patient populations, such as those of lower socioeconomic status, or individuals with preexisting social and medical complexities.
According to a new study conducted by researchers at the OHSU Center for Health Systems Effectiveness, in order to obtain financial incentives or avoid penalties under Care for Joint Replacement, hospitals serving a higher percentage of low-income patients must reduce health care spending more substantially than their counterparts. Unsurprisingly, these hospitals also were more likely to be penalized.
“Overall, it appears that participating hospitals were able to decrease total spending overall, with no adverse outcomes under the CJR program,” says the study’s lead author Hyunjee Kim, Ph.D., a health economist at the OHSU Center for Health Systems Effectiveness. “However, challenges in program benchmarks are apparent and may cause tremendous disadvantage to hospitals serving vulnerable populations, which could restrict the ability to provide broad, and often times necessary, services to patients.”
To help reach parity among Care for Joint Replacement hospitals and increase the rates of cost savings and earned incentives, Kim and colleagues suggest program modifications consider social and medical complexities in favor of hospitals serving low-income patients when setting future spending benchmarks.
The full report is published online in JAMA Network Open.
This study was supported by the National Institute on Minority Health and Health Disparities (R01MD01140), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR055259), both part of the National Institutes of Health.