Comparing BPCI and CJR joint replacement approaches: 5 study findings

Hospitals participating in joint replacement bundles through voluntary and mandatory CMS programs have various different organizational characteristics, but they also have similarities in baseline spending and quality, a study published in Health Affairs found.

For the study, researchers compared hospitals participating in joint replacement bundles through Medicare's voluntary Bundled Payments for Care Improvement's model 2 and mandatory Comprehensive Care for Joint Replacement Model through March 2017. They examined myriad data, including data from CMS to identify BPCI and CJR hospitals; Medicare data from 2010-16; data from CMS via Hospital Compare; and data from 2013-15 from the American Hospital Association Annual Survey.

Five findings from the study:

1. BPCI hospitals generally were larger than CJR hospitals, with the average number of beds at 325 compared to 264, respectively. It also found BPCI hospitals had higher average Medicare patient volume (nearly 7,200 compared to about 5,300).

2. BPCI hospitals were more likely to be nonprofit, teaching hospitals and sole community providers compared to CJR hospitals. CJR hospitals were more likely to be safety-net hospitals.

3. Both BPCI and CJR hospitals were similar as far as baseline readmission rates and mortality rates, according to the study.

4. BPCI hospitals had greater cost from institutional post-acute care, primarily due to inpatient rehabilitation facility cost, but researchers note the differences are not large.

5. The study's authors concluded: "These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs."


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