Impact of the Comprehensive Care for Joint Replacement Model on Patient Reported Outcomes

The Centers for Medicare & Medicaid Services sought to determine whether the Comprehensive Care for Joint Replacement (CJR) model--a mandatory episode-based payment program for knee and hip replacement surgery--affected patient-reported measures of quality. The CJR model was known to reduce Medicare’s expenditures by reducing institutional post-acute care (PAC). But, while the model did not affect readmissions, emergency department visits, or mortality, Medicare wanted to know how the model may have affected patient-reported measures of quality.

In this study, published in Health Services Research, Abt analyzed survey responses from 8,433 CJR beneficiaries and 9,014 control beneficiaries and found that, after their 90-day episode, patient functional status and satisfaction were, on average, not adversely affected by the payment model. However, CJR respondents were slightly more likely to depend on caregivers for certain daily activities when they returned home (either directly from the hospital or after an institutional post-acute care stay). The findings suggest that policymakers and payers may benefit from future research assessing the impact of new payment models on patients’ caregivers.