The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty.
Kara Kallies, Timothy R Dillingham, Adam Edelstein and 5 others
PMID 35760109WHAT IT FOUND
Patients discharged to rehab facilities in bundled-payment areas were less likely to return home by 90 days compared to those in non-bundled areas.
However, overall escalation to institutional care decreased over time regardless of the policy.
Key findings
01Patients initially discharged to an inpatient rehab facility or skilled nursing facility in CJR areas had significantly lower odds of returning to the community at 90 days compared to those in non-CJR areas.
02Regardless of the payment model, patients initially discharged to the community were less likely to escalate to institutional care in 2017 compared to 2014-2015.
03The study observed a marked reduction in the proportion of patients initially discharged to institutional settings from the pre-policy period to the post-policy period.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study relies on claims data, which lacks clinical detail on why specific discharge decisions were made. The analysis is restricted to fee-for-service Medicare beneficiaries aged 66 and older, so findings may not apply to younger patients or those with other insurance. It was not a randomized trial, so residual confounding from other healthcare system changes during the study period cannot be ruled out. Hospitals that opted out of the mandatory CJR model to join a voluntary program were included in the control group, which may dilute the observed policy effects.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that the bundled payment model directly caused worse discharge outcomes for institutional patients. The study found an association, but the overall trend toward less escalation of care was unrelated to the policy, and the specific finding on return to community had a modest effect size.