December 09, 2019
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Joint replacement program may reduce margin for savings vs bundled payment model

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James D. Slover

Published results showed use of the Comprehensive Care for Joint Replacement model may substantially reduce the margin for savings compared with the Bundled Payments for Care Improvement model.

Using historical data from NYU Langone Orthopedic Hospital, James D. Slover, MD, MS, and colleagues calculated the mean cost per episode of care of major joint replacement or reattachment of a lower extremity with or without major complications or comorbidities and with or without fracture. Researchers established and comparatively analyzed the target prices, projected savings or losses per episode of care and projected annual savings for both Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models.

Results showed a decrease in CJR target price by 24% for major joint replacement or reattachment of a lower extremity with major complications or comorbidities for patients without fracture and 22.8% for patients with fracture compared with BPCI target prices. For major joint replacement or reattachment of a lower extremity without major complications or comorbidities, researchers found a decrease in CJR target prices of 26.1% and 27.7% for patients without vs. with fracture, respectively. Researchers noted CJR may result in a reduction in savings per episode of care by 92.8% and by 166% for major joint replacement or reattachment of a lower extremity with major complications or comorbidities for patients without and with fracture, respectively. There may also be a reduction in savings per episode of care by 94.9% for major joint replacement or reattachment of a lower extremity without major complications or comorbidities in patients without fractures and by 61.7% in patients with fractures, according to results. Under CJR, researchers found a decrease in their institution’s projected annual savings of 83.3%.

“CJR is an alternative bundled payment program that encourages and rewards quality and efficiency of care,” Slover told Healio.com/Orthopedics. “Success will require continued ongoing improvement and innovation efforts, even for centers that have had success in previous bundled payment programs, such as BPCI.” – by Casey Tingle

 

Disclosures: Slover reports he is a steering committee member for the AJRR Hip Society; a board member of the American Association of Hip and Knee Surgeons, Hip Society, Knee Society and PCORI Advisory Board for Shared Decision-Making; receives payment for lectures including service on speakers bureaus from Pacira; and research support from Biomet and Smith & Nephew. Please see the study for a list of all other authors’ relevant financial disclosures.