New AHRQ grant explores spillover of Medicare's Comprehensive Joint Replacement program

Four-year award is investigator Hyunjee Kim's second on the topic

Following up on her earlier work funded by the National Institutes of Health, CHSE investigator Hyunjee Kim has received a four-year, $1.5 million award to study the Centers for Medicare and Medicaid Services' new Comprehensive Joint Replacement bundled-payment program and assess whether its effects are "spilling over" to patients covered by other forms of insurance.  

The Comprehensive Joint Replacement model or "CJR" is part of Medicare's move to replace the fee-for-service payment structure with alternative forms of payment that reward quality and efficiency. Medicare introduced the CJR program in April 2016, rolling it out at hospitals in 67 randomly selected metropolitan areas in the United States.

Hospitals in the CJR program receive a single "bundled" payment for each hip or knee replacement they perform on Medicare enrollees. This payment covers the surgery and hospitalization, plus all care that patients receive for the next 90 days, regardless of how much care that is.  Medicare policy-makers hope that holding hospitals accountable for all related costs will encourage them to deliver care efficiently and reduce wasteful spending.  

Dr. Kim's first study on CJR, which is two years underway, examines the effect of the program on racial disparities in outcomes of joint-replacement surgery, including questions of whether the program inadvertently penalizes hospitals in lower-income communities (see photo).

The new grant, funded by the Agency for Healthcare Research and Quality, looks at whether changes that hospitals make to care provision under CJR "spill over" to patients not covered by Medicare. For example, if hospitals change how they contract for post-surgical care with skilled nursing facilities, the change could well affect all patients served by the hospital, not just those with Medicare coverage.

Stay tuned for updates and publications from this new work!

Thomas Meath at ARM with CJR team poster
Senior Research Associate showing the CJR team's research poster at Academy Health, Washington D.C.