Research Objective The Comprehensive Care for Joint Replacement (CJR) model is intended to encourage participant hospitals to reduce Medicare payments by coordinating care with the physicians, post‐acute care (PAC) providers, and other providers involved in an episode of care for a lower extremity joint replacement (LEJR), which comprises the surgery plus the services provided in the 90 days after hospital discharge. Previous studies have documented reductions in institutional PAC attributable to the model.1 The shift towards less intensive PAC could affect patient experiences and recovery. We surveyed Medicare fee‐for‐service (FFS) beneficiaries after LEJR surgery to document their self‐reported functional status, pain, satisfaction with care management and overall recovery, care transitions, and dependence on caregivers for help with activities of daily living. These patient‐reported outcomes are important indicators of quality that cannot be measured using secondary data. Study Design In 2018, participation in CJR was mandatory for hospitals that that did not meet rural or low‐volume exemptions, and were located in 34 randomly‐selected, historically high‐payment metropolitan statistical areas (MSAs). We surveyed a census of Medicare FFS beneficiaries who had LEJR surgery in mandatory CJR hospitals, and those who had LEJR surgery in hospitals within 47 high‐payment MSAs randomly assigned to the control group. Patients received the survey approximately 90 to 120 days after hospital discharge. We estimated risk‐adjusted differences between CJR and control respondents. Population Studied We sampled beneficiaries who had LEJR surgery in March, April, August or September 2018 from the CJR group (12,478 beneficiaries) and the control group (13,137 beneficiaries). Response rates for the survey were similar for the CJR and control groups (67.6% and 68.6%, respectively). Principal Findings The CJR model did not have a significant impact on patient‐reported functional status, pain, satisfaction with care management or satisfaction with overall recovery. However, CJR respondents were 1.2 percentage points less likely to report that they received the right amount of care in the two weeks after hospital discharge than control respondents (p < 0.01), and CJR respondents required more caregiver help at home than control respondents (a difference of 1.9 points on a 100‐point scale, p < 0.01). Conclusions The CJR model resulted in a small increase in the number of respondents who reported that they needed caregiver help after returning home. This is consistent with previous findings that CJR patients were less likely to use institutional PAC and were more likely to go directly home after surgery than control respondents. However, this did not result in decreased functional status or satisfaction with care management and recovery. This suggests that greater dependence on caregivers did not translate to lower satisfaction or worse functional recovery. Implications for Policy or Practice Results show that CJR reduced Medicare paym...
Research Objective The Comprehensive Care for Joint Replacement (CJR) model is intended to encourage participant hospitals to reduce Medicare payments by coordinating care with the physicians, postacute care (PAC) providers, and other providers involved in an episode of care for a lower extremity joint replacement (LEJR), which comprises the surgery plus the services provided in the 90 days after hospital discharge. Although participant hospitals are incentivized to improve or maintain quality of care, reductions in institutional PAC attributable to the model could have adverse effects on patient recovery and care experiences.1 We surveyed Medicare fee‐for‐service (FFS) beneficiaries a few months after LEJR surgery to document their self‐reported functional status, pain, satisfaction with care management and overall recovery, care transitions, and dependence on caregivers for help with activities of daily living (ADLs). These patient‐reported outcomes are important indicators of quality that cannot be measured using secondary data. Study Design From 171 metropolitan statistical areas (MSAs) that met CJR eligibility criteria, the Centers for Medicare & Medicaid Services (CMS) randomly selected 67 for CJR and 104 for the control group. Participation in CJR was mandatory for all hospitals in the 67 selected MSAs during the time covered by our analysis. We surveyed a stratified random sample of Medicare FFS beneficiaries who had LEJR surgery in CJR hospitals and a matched group of beneficiaries who had surgery in control hospitals. Patients received the survey approximately 90 to 120 days after hospital discharge. We estimated risk‐adjusted differences between CJR and control respondents on all outcomes. Population Studied Medicare FFS beneficiaries who had LEJR surgery in March, April, August, or September 2017 were sampled from the CJR intervention group (7,604 beneficiaries) and the control group (7,188 beneficiaries). We oversampled patients with hip fractures to assess results for beneficiaries who may be most sensitive to care changes made by hospitals in response to CJR model incentives. Response rates for the survey were similar for the CJR and control groups (70.7% and 71.4%, respectively). Principal Findings The CJR model did not have a significant impact on patient‐reported functional status, pain, satisfaction with care management and overall recovery, and care transitions. The only significant difference was that CJR respondents reported needing more caregiver help putting on or taking off clothes after returning home than did control respondents. On a 100‐point scale, the difference was ‐2.3 points (P < .01). All measures were similar for CJR and control respondents with hip fractures. Conclusions The CJR model resulted in a small increase in reported caregiver help needed after patients returned home. Functional status and satisfaction with care and recovery roughly 90 to 120 days after hospital discharge, however, were not affected by the model, indicating that concerns about dependence on caregivers ...
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