Finkelstein A, et al. - Interim outcomes from the first year of implementation of a bundled payment model for lower extremity joint replacement (LEJR) were assessed and reported. A significantly lower percentage of discharges to institutional post-acute care was observed in this interim analysis of the first year of the Comprehensive Care for Joint Replacement (CJR) bundled payment model for LEJR among Medicare beneficiaries, Medicare & Medicaid Services, and eligible metropolitan statistical areas (MSAs) covered by CJR compared with those that were not but no significant difference in total Medicare spending per LEJR episode.

Methods

• Eligible MSAs were randomized to the CJR bundled payment model for LEJR episodes or to a control group as part of a 5-year, mandatory-participation, randomized trial by the Centers for Medicare & Medicaid Services.
• Hospitals received bonus payments in the first performance year if Medicare spending for LEJR episodes was below the target price and hospitals met quality standards.
• First-year data on LEJR episodes starting April 1, 2016, with data collection through December 31, 2016, were reported.
• Exposure included the randomization of MSAs into the CJR bundled payment model group (75 assigned; 67 included) or to the control group without the CJR model (121 assigned; 121 included).
• To evaluate the relationship between inclusion of MSAs in the CJR model and outcomes, instrumental variable analysis was used.
• The share of LEJR admissions discharged to institutional post-acute care was the primary outcome.
• The number of days in institutional post-acute care, discharges to other locations, Medicare spending during the episode (overall and for institutional post-acute care), net Medicare spending during the episode, LEJR patient volume and patient case mix, and quality-of-care measures comprised the secondary outcomes.

Results

• Data showed that, among the 196 MSAs and 1633 hospitals, 131,285 eligible LEJR procedures were performed (mean volume, 110 LEJR episodes per hospital) among 130,343 patients (mean age, 72.5 [standard deviation (SD): 0.91] years; 65% were women; 90% were white) during the study period.
• Findings suggested the mean percentage of LEJR admissions discharged to institutional post-acute care to be 33.7% (SD: 11.2%) in the control group and 2.9 percentage points lower (95% confidence interval [CI]: -4.95 to -0.90) in the CJR group.
• In the control group, mean Medicare spending for institutional post-acute care per LEJR episode was $3,871 (SD: $1,394), and, in the CJR group, it was $307 lower (95% CI: -$587 to -$27).
• In the control group, mean overall Medicare spending per LEJR episode was $22,872 (SD: $3,619), and, in the CJR group, it was $453 lower (95% CI: -$909 to $3)—a statistically nonsignificant difference.
• Results did not demonstrate any of the other secondary outcomes to differ significantly between groups.