- Safety net hospitals participating in Medicare's Comprehensive Care for Joint Replacement (CJR) bundled payment model were less likely to receive rewards than other facilities in the program, according to a study published Monday in JAMA.
- Researchers determined the safety net hospitals were also more likely to be penalized in the program’s second year for exceeding spending benchmarks.
- The results could be because of inferior, higher-cost care from safety net hospitals or because CJR doesn't account for the increased social vulnerability of patients in those facilities. "Although CJR penalties may motivate hospitals to improve, the CJR may also exacerbate disparities by taking away financial resources that safety net hospitals need for improving quality," the study authors said.
CMS has previously been under fire for programs that may inadvertently penalize safety net and critical access hospitals. Earlier JAMA research on CJR showed that larger hospitals with higher patient volumes are more likely to perform better in the model.
CJR is a five-year model aiming at improving care for fee-for-service beneficiaries receiving hip and knee replacements. The program involves bundling payments for the joint replacement surgeries with 90 days of post-discharge care.
CJR, kicked off in 2016 and running through December 2020, is unusual for CMS models in that the agency made it mandatory for the roughly 700 participating hospitals in the programs first two years. The agency under the Trump administration has generally shied away from forcing participation in new payment programs, although officials have hinted that the idea isn't off the table entirely.
Providers balk at being conscripted into new models, but some experts argue mandatory programs provide better data for evaluating effectiveness and can serve as a needed push for change in the industry's overall shift toward paying for value.
And joint replacements are an area ripe for improvement. Earlier research has found avoiding inappropriate joint replacements alone could save more than $8 billion a year.
Early results from CJR have shown modest success. In the first two years, spending on hip and knee replacements at participating hospitals went down by 3%, with no significant difference in complications or percentage of procedures on high-risk patients.