CJR Outcomes Vary Widely, Driven by 2 Factors

Christopher Cheney, January 11, 2017

Low-performing hospitals must focus on reducing complications and readmissions to close the gap on high-performing organizations, researchers say.

Donald Fry, MD
Donald Fry, MD

Clinical outcomes for hip and knee replacement surgery vary widely from hospital to hospital, and there are significant opportunities to boost patient care and to lower costs.

Two factors—inpatient complications of care and readmissions following discharge—are prime drivers of clinical performance levels for hip and knee replacement procedures, according to research published in The Journal of Bone & Joint Surgery.

The findings show the need for improvement among poor-performing hospitals, stated Donald Fry, MD, lead author of the research and executive vice president for clinical outcomes at MPA Healthcare Solutions. He made his remarks in a media release.

Medicare's Comprehensive Care for Joint Replacement (CJR) bundled payment model requires mandatory hospital participation in 67 geographic areas of the country.

Under CJR, Medicare bundles payments for hip and knee replacement procedures for hospital, professional, and other patient services through 90 days post-discharge.


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CJR has established a powerful financial incentive for low-performing hospitals to curtail complications and readmissions, the researchers wrote.

Under the CJR, it is imperative that organizations understand the "excess costs" of total patient care. "Because most hospitals have already improved inpatient efficiency, reductions in complications and readmissions must become the focus of attention," they wrote.

Methodology
The research is based on Medicare Limited Data Set information collected from 2010 to 2012. The data set features clinical outcome information from 253,978 total hip replacement patients and 672,515 total knee replacement patients.

For hip replacements, the researchers examined data from 1,483 hospitals. For knee replacements, the researchers examined data from 2,349 hospitals.

The data were risk-adjusted for several factors including patient comorbidities. Adverse-outcome rates were based on factors such as patient death and prolonged lengths of stay.

Christopher Cheney

Christopher Cheney is the senior finance editor at HealthLeaders Media.

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