CJR Outcomes Vary Widely, Driven by 2 Factors
The Outcome Gap
The risk-adjusted data found a wide gap in the adverse-outcome rates at the top 10% of high-performing hospitals compared to the bottom 10% of low-performing hospitals.
For hip replacement procedures, the top 10% of high-performing hospitals posted a 6.6% adverse-outcome rate compared to a 19.8% adverse-outcome rate for the bottom 10% of low-performing hospitals.
For knee replacement procedures, the top 10% of high-performing hospitals posted a 6.4% adverse-outcome rate compared to a 19.3% adverse-outcome rate at the bottom 10% of low-performing hospitals.
Closing the gap between high-performing and low-performing hospitals would generate significant clinical benefits for patients and cost savings for taxpayers, the authors wrote.
"Improvement of suboptimally performing hospitals to the mean level would have a dramatic impact on patient morbidity and costs," they wrote.
The trend toward shorter inpatient stays for hip and knee replacement is having a significant impact on complication and readmission rates, the researchers stated.
"The trend to shorter lengths of stay and early transfer of frail patients to skilled nursing and rehabilitation facilities means that many complications of care are not identified until after discharge," they wrote.
To achieve clinical and financial success in bundled payment programs such as CJR, hospitals must have a firm grasp on what happens to their patients in postacute care settings such as skilled nursing facilities.
"Too often, hospitals don't know their own outcomes," Fry said.
Often, neither the hospital nor the surgeons are aware of post-discharge deaths without readmissions, or readmissions that occurred in facilities other than where the original operation was performed, he stated.