When the Centers for Medicare and Medicaid Systems introduced its Comprehensive Care for Joint Replacement Model (CJR), an immediate concern among researchers and advocates was whether the new payment bundle might adversely affect patients of color.
That was because CJR, which holds hospitals accountable for both quality and all costs for 90 days surrounding a hip or knee replacement, did not make adjustments for patients’ medical and social complexity. The program was implemented on a mandatory basis in a randomized selection of metropolitan statistical areas (MSAs), meaning hospitals in those areas had no option not to participate.
This led to fears that the program might cause hospitals to decline to offer those procedures to Black and Hispanic patients, who face disproportionate medical and social complexities. Black and Hispanic Medicare beneficiaries were already receiving joint replacements at only 40-50% of the rate of white Medicare beneficiaries when CJR began.
Research from CHSE published today in JAMANetworkOpen shows outcomes on rates of hip and knee replacements for Black, Hispanic and white enrollees before and after implementation of CJR, comparing results from hospitals in 65 “treatment” (CJR) metropolitan statistical areas (MSAs) with those in 101 “control” MSAs.
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About the Center for Health Systems Effectiveness
The Center for Health Systems Effectiveness researches health care service delivery with the aim of improving the value and sustainability of the U.S. healthcare system. Our mission is to provide the analyses, evidence and economic expertise to build a better and more sustainable health care system.
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