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Brown study: No way to predict readmission risk under CJR

CMS launched the Comprehensive Care for Joint Replacement model in April 2016 to compel hospitals to better coordinate care for joint replacement surgery patients in an effort to reduce readmissions and use of expensive post-acute services. The CJR model imposes penalties on hospitals for readmissions of lower extremity joint replacement patients within 90 days of surgery, but a new study from Brown University finds there is no adequate index for predicting readmission risk.

Some hospital systems have taken issue with the fact that the CJR's current payment model does not include a system for adjusting risk to account for variances in patients' medical complexity or functional status, said Amit Kumar, PhD, lead study author and a postdoctoral research associate at the Brown University School of Public Health, according to a Brown report on the study.

Dr. Kumar and his co-authors tested the three best joint replacement candidate risk adjustment indices, including one created by CMS, but determined that none led to accurate predictions of readmissions among patients who underwent joint replacement surgeries for osteoarthritis, according to the report.

The study authors concluded that there is a need for an index that can accurately predict the risk of patient readmissions to both improve patient care and help CMS fairly judge hospitals on the quality of their care, rather than impose penalties that do not account for inherent risk.

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