Examining Racial Differences in Medicare Bundled Payment Joint Replacement Model

Medicare’s Comprehensive Care for Joint Replacement (CJR) model exists to improve care quality and control spending for older adults needing joint replacement services. Researchers of a study published in JAMA Network Open sought to better understand the association of the mandatory bundled payment model and potential racial disparities.

“There are marked racial/ethnic differences in hip and knee joint replacement care as well as concerns that value-based payments may exacerbate existing racial/ethnic disparities in care,” said Hyunjee Kim, PhD, Center for Health Systems Effectiveness, Oregon Health & Science University, and colleagues.

Dr Kim and fellow researchers conducted a cohort study of 688,346 Black, White, and Hispanic patients under the CJR model who received a joint replacement. The study examined Medicare claims from 2013 through 2017 for joint replacement procedures in 67 treatment and 103 metropolitan statistical areas.

Results of the study show that the model decreased readmission rates for Black patients.

“Furthermore, Black patients experienced a greater decrease in discharges to institutional postacute care relative to White patients, representing relative improvements despite concerns that value-based payment models may exacerbate existing disparities,” said the researchers.

Under the CJR model, spending for White patients decreased by $439 but did not change for Black or Hispanic patients. The authors explain that these differences could stem from the Center for Medicare & Medicaid Services’ method of not adjusting for patients preexisting social or medical complexity, which can effect spending.

“For example, patients without reliable caregivers or transportation may require institutional postacute care and incur higher costs than patients who go home directly after joint replacement,” explained the researchers. “Socially or medically complex patients are also more likely to experience complications after a surgery, leading to higher readmission rates and higher spending.”

Overall, the CJR model shows success at reducing costs and rates of readmission for patients undergoing joint replacement, but the researchers note that challenges and disparities still exist.

“We also need more research to understand whether CJR-participating hospitals reduced use of institutional postacute care for Black patients even when they had medical and social needs for institutional postacute care,” concluded the researchers.

—Edan Stanley

Reference:
Kim H, Meath THA, Tran FW, Quiñones AR, McConnell KJ, Ibrahim SA. Association of Medicare mandatory bundled payment system for hip and knee joint replacement with racial/ethnic difference in joint replacement care. JAMA Netw Open. 2020;3(9):e2014475. doi:10.1001/jamanetworkopen.2020.14475