Study: CJR unintentionally penalizes hospitals, does not account for medical complexity

Emily Rappleye -

The Comprehensive Care for Joint Replacement program — a bundled payment program implemented by CMS — may inadvertently be penalizing hospitals because it lacks risk adjustment, according to a recent study in Health Affairs.

Researchers determined this by analyzing Medicare claims for lower extremity joint replacement patients from 2011 to 2013. They applied the same payment methodology as CMS uses for bundled payments. The researchers found with each standard deviation increase in a hospital's patient complexity, the net difference in bonus payments dropped $827 per episode of care. They also found adding risk adjustment to the methodology could increase bonus payments to some hospitals by more than $114,000 each year.

"Our findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs," the authors conclude.

 

More articles on finance:

4 questions with Dignity Health SVP of finance, revenue cycle
The most and least expensive Illinois hospitals for observation care
For-profit hospital stock report: Week of Sept. 6-9

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.