The Medicare-implemented Comprehensive Care for Joint Replacement (CJR) bundled-payment model reduces spending for hip or knee replacement, according to a study published online Jan. 2 in the New England Journal of Medicine.

Michael L. Barnett, M.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues used Medicare claims from 2015 through 2017 encompassing the first two years of bundled payments in the CJR program to conduct difference-in-differences analyses. Hip or knee replacement episodes were evaluated in 75 metropolitan statistical areas randomly assigned to mandatory participation in the CJR program (treatment areas) and 121 control areas before and after CJR model implementation.

The researchers identified a total of 280,161 hip or knee replacement procedures in 803 hospitals in the treatment areas and 377,278 procedures in 962 hospitals in control areas during 2015 through 2017. Treatment areas had greater decreases in institutional spending per joint replacement episode versus control areas after initiation of the CJR model (differential change, −$812, or a −3.1 percent differential decrease). The reduction was mainly driven by a 5.9 percent relative decrease in the percentage of episodes in which patients were discharged to post-acute care facilities.

"Through the first two years of the CJR program, the program modestly reduced payments per hip- or knee-replacement episode without any significant change in rates of complications," the authors write.

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