Comprehensive Care for Joint Replacement model penalized safety-net hospitals
Results showed safety-net hospitals and hospitals with greater populations of Black and Hispanic patients have struggled to meet the lower spending benchmarks implemented by Medicare and the Comprehensive Care for Joint Replacement model.
“Medicare lowered spending targets for high-risk hospitals by shifting from hospital-specific targets to multi-hospital shared targets that did not account for differences in medical or social case mix between hospitals,” the researchers wrote in the study.
To analyze the trends in penalization status and equity implications under the Comprehensive Care for Joint Replacement (CJR) model as Medicare expands bundled payments, researchers analyzed 735 hospitals (2,161 hospital-years) from 2016 to 2019. Safety-net hospitals were defined as those in the top quintile of the Disproportionate Share Hospital index, according to the study.
Researchers found the highest annual participation in CJR was 702 hospitals in 2017, while the lowest annual participation was 389 hospitals in 2018. Researchers noted the percentage of mandatory participant hospitals that were penalized for exceeding spending benchmarks increased every year during the study period. They also found safety-net hospitals and hospitals with greater populations of Black and Hispanic patients were disproportionately penalized.
In 2017, 23.1% of mandatory participant hospitals (n =162), 39.3% of safety-net hospitals (n= 5) and 41.4% of hospitals with greater populations of Black and Hispanic patients (n = 58) were penalized. Even after allowing low-cost hospitals to exit the CJR in 2018, 44.5% of mandatory participant hospitals (n= 173), 69.7% of safety-net hospitals (n= 62) and 64.4% of hospitals with greater populations of Black and Hispanic patients (n= 58) were penalized. Similarly in 2019, 52.8% of mandatory participant hospitals (n= 209), 87.9% of safety-net hospitals (n = 80) and 71.7% of hospitals with greater populations of Black and Hispanic patients (n = 66) were penalized.
“These lower spending benchmarks may have been less attainable for safety-net hospitals and hospitals with high Black and Hispanic populations, in part because they serve patients who have greater needs engendered by systemic barriers to care and thus remain persistently high spending,” the researchers wrote.
“Policymakers should ensure that hospitals receive achievable spending benchmarks to avoid widening disparities in care,” they concluded.
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