Mandatory joint pay model slashes spending in just eight months

A mandatory pay model aimed at reducing Medicare spending on joint replacement surgeries was able to save money in its first year. The CMS in recent years has scaled back and canceled mandatory models.

Under the Comprehensive Care for Joint Replacement program, average total payments decreased by 3.9% or $1,127 compared to hospitals not participating in the model, according to federal data released Wednesday. At the same time, researchers observed no statistically significant changes in the quality of care as measured by readmission rates, emergency department visits, and deaths.

The program gives hospitals a fixed payment for all services related to joint replacement surgeries from admission to 90 days after the procedure, with no additional payments for complications, readmissions or post-acute services.

“Possibly the most notable outcome during the first CJR model performance year was that statistically significant changes in utilization and payments occurred so quickly,” the report said.

The study analyzed results from 731 CJR participant hospitals and 841 hospitals not in the experiment, which lasted from April 1 to Dec. 31, 2016.

Last year, the CMS scaled back the CJR program citing the burden of the program and the belief that models should be largely voluntary. The CJR model is now only mandatory in 34 geographic areas compared to 67 geographic areas when it first launched.

The agency estimates that 465 hospitals are participating in the effort. That figure is down from 800 acute-care hospitals that were expected to participate in the program.

By Virgil Dickson | Modern Healthcare

Image Credit: Getty Images


About Peter Coffaro 602 Articles
A growth-driven and strategic executive, Peter Coffaro commands more than 20 years of progressive management success within the medical device industry. As a District Sales Manager for Stryker Orthopaedics, Peter was responsible for managing and directing a regional sales force to achieve sales and profit goals within the Rocky Mountain region. Previously, he was the Director of Sales & Marketing for Amp Orthopedics. In this role, Peter was responsible for planning, developing, and leading all sales and marketing initiatives. Peter is a former orthopedic distributor in the Pacific Northwest. He has also worked with DePuy Orthopaedics as well as Zimmer, and held positions in sales, sales training, and sales management. Peter has an extensive background in organizational development, business development, sales management, negotiating and P&L management. Peter holds a B.S. degree in Biology from Northern Illinois University.

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