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Certain hospital characteristics linked to withdraw from CJR program
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Recently published results showed worse performance and a greater percentage of socially vulnerable patients among hospitals that withdrew from the Comprehensive Care for Joint Replacement program when it became voluntary.
To describe hospital characteristics in the first year of the Comprehensive Care for Joint Replacement (CJR) program participation, Hyunjee Kim, PhD, and colleagues used Medicare fee-for-service claims data for all patients who received major lower extremity joint replacements in 2015, CMS provider of service files and provider-specific files, and Hospital Compare datasets. Researchers calculated the marginal effect of each hospital characteristic, as well as percentage-point changes between hospital characteristics and the likelihood of CJR exit.
In 2018, results showed 73% of the 280 hospitals in the 33 voluntary metropolitan statistical areas left the CJR program. Researchers found a greater proportion of non-white and Medicaid-enrolled patients and a low volume of joint replacements in the hospitals that left the CJR program vs. hospitals that remained in the program. Hospitals that left the CJR program also had worse performance, according to results, with longer hospital stays, more institutional post-acute care use and greater readmission rates. Researchers noted these results suggested greater CJR episode spending. Results showed hospitals that left the CJR program were less likely to have received reconciliation payments vs. hospitals that remained in the program, as well as lower patient-reported outcome submission rates.
“Hospitals that left the CJR program when it became voluntary served a higher percentage of socially vulnerable patients and performed poorly in the program,” Kim told Healio.com/Orthopedics. “However, patients at these hospitals may be the ones who would gain the most from improvements in care coordination.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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Kim H, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.4743.
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