Medicare joint replacement program could succeed in more regions, Health Affairs study says
Expanding the Comprehensive Care for Joint Replacement (CJR) program would warrant similar positive results for new participants, according to a new Health Affairs report.
CMS implemented the mandatory bundled payment program in 2016 with the intention of studying how it would perform if it were scaled nationally beyond the 67 markets originally used.
The new study, which was funded by The Commonwealth Fund, found that 129 other regions have "largely similar baseline hospital episode quality and spending" as the original CJR markets.
CJR, which was the first mandatory alternative payment model, has seen some success. A recent New England Journal of Medicine report found that the first two years of the program saw a "modest reduction" of 3% in spending for hip or knee replacements.
Hospitals in the CJR model enjoyed a larger decrease in spending per joint replacement episode than those in the control group. A nearly 6% drop in the percentage of episodes in which patients were discharged to post-acute care facilities was one reason for the lower spending. Another study found that the CJR led to a significantly lower percentage of discharges to institutional post-acute care.
In August, CMS said the model cut spending by almost 4% for participating hospitals without impacting quality of care on any significant metrics.
Despite those positives, there have still been questions as to whether expanding CJR to other areas would result in the same success.
The new Health Affairs report tested the question by using data from Medicare, the American Hospital Association and the Health Resources and Services Administration. The researchers found differences in structural market and hospital characteristics but discovered similarities when it came to quality and spending.
They suggested that Medicare could expect similar results by scaling CJR into more urban markets.
The new report comes as CMS appears divided on mandatory versus voluntary programs. The early days of the Trump administration saw CMS promote the need for more flexibility for providers, including not forcing them into mandatory payment models. That's despite research showing the advantages of programs that require participation.
Critics of voluntary programs say they don't offer an accurate picture since providers self-select. Mandatory programs provide a better gauge of a program's success and allow researchers more data to figure out what works and what doesn't.
However, in November, HHS Secretary Alex Azar offered a possible new mandatory payment program for radiation oncology and cardiac health in a shift from the Trump administration's previous stance.
Another issue still facing CMS is that providers aren't usually interested in taking on more risk. The agency's recent "Pathways to Success" looked to address that issue in the Medicare Shared Savings Program. CMS is hoping to get providers to take on risk in the value-based payment model quicker. However, providers remain cool to that idea.