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. 2022 Dec;103(12):2398-2403.
doi: 10.1016/j.apmr.2022.05.018. Epub 2022 Jun 26.

The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty

Kara Kallies  1 , Timothy R Dillingham  2 , Adam Edelstein  3 , Eric Hume  4 , Daniel Polsky  5 , Roy Schwartz  6 , Emily L McGinley  7 , Liliana E Pezzin  1
Affiliations

The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty

Kara Kallies et al. Arch Phys Med Rehabil. 2022 Dec.

Abstract

Objective: To evaluate the effect of the Comprehensive Care for Joint Replacement (CJR) policy on the 90-day trajectory of post-acute care after a total hip arthroplasty (THA).

Design: Multivariable difference-in-difference models applied to Medicare beneficiaries undergoing a THA prior to (2014-2015) and post-CJR implementation (2017) in areas subjected to or exempt from the policy.

Setting: Hospitals in standard metropolitan statistical areas.

Participants: 357,844 elderly Medicare patients nationwide undergoing THA (N=357,844).

Interventions: None.

Main outcome measures: Escalation in care to institutionalization (ie, admission to an inpatient rehabilitation or skilled nursing facility during 90-days postdischarge for those initially discharged to the community and return to the community at the end of the episode of care among those initially discharged to an institutional setting).

Results: Of the 357,844 elderly Medicare patients nationwide undergoing THA during the study period, 47.6% were discharged directly to the community and 52.4% received post-acute care in an institution. Patients discharged to an institution post-policy in a CJR area were about 10% less likely to return to the community (odds ratio=0.91; 95% confidence interval, 0.84-0.98; P=.02) at the end of the 90-day episode of care than those treated in policy-exempt areas. Despite the large magnitude, estimates of escalation in care among patients treated in bundling areas post-CJR implementation were not statistically significant.

Conclusions: Our findings support further exploration of unanticipated effects of mandatory bundled payment policies on outcomes, as well as further examination of outcomes among policy-relevant subgroups of patients undergoing hip replacement in the United States.

Keywords: Arthroplasties; Patient Care Bundles; Post-acute Care; Rehabilitation.

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Conflict of interest statement

Disclosures

The authors have no conflicts of interest to disclose.

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References

    1. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA - Journal of the American Medical Association. 2021;325(6):568–578. doi:10.1001/jama.2020.22171 - DOI - PMC - PubMed
    1. Agency for Healthcare Research and Quality. HCUP Fast Stats - Most Common Operations During Inpatient Stays. Accessed May 20, 2021. https://www.hcupus.ahrq.gov/faststats/NationalProceduresServlet
    1. Singh JA, Yu S, Chen L, Cleveland JD. Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample. The Journal of Rheumatology. 2019;46(9). doi:10.3899/jrheum.170990 - DOI - PubMed
    1. Centers for Medicare and Medicaid Services. Comprehensive Care for Joint Replacement Model. Accessed May 31, 2021. https://innovation.cms.gov/innovation-models/cjr
    1. Centers for Medicare & Medicaid Services (CMS). Medicare Program: Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing; Medicare and Medicaid Programs; Policies and Regulatory Revisions in Response to the COVID–19 Public Health Emergency. Department of Health and Human Services.Centers for Medicare & Medicaid Services (CMS); 2021:23496–23576.

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