The Comprehensive Care for Joint Replacement (CJR) model is program begun by CMS in April 2016 that aims to improve care and reduce costs for patients undergoing knee and hip replacement surgery (DRGs 469 and 470). Over 700 hospitals, in addition to post-acute care providers, participate in the program and receive risk-adjusted bundled payments for each episode. This analysis looks at those replacements without major complicating conditions (DRG 470) and without hip fracture. The top ten hospitals with the lowest average cost per episode and the top ten hospitals with the greatest number of episodes are presented below.
The hospitals with the lowest average episode costs tended to have short lengths of stay and an especially low episode volume. While most also had extremely low readmission rates, it is probable that it is an anomaly due to the small number of overall cases. In the cases of the three surgical hospitals, their low episode volume is attributable to their small size (fewer than 23 staffed beds). Many of the hospitals had direct control over nearly the entirety of the episode. Anchor hospital spending, or the cost of care at the initial admitting hospital, took up 80 to 90 percent of all costs for many of the top 10, despite a median value of 64 percent for all hospitals in the CJR program. As would be expected, a reduction in post-acute care utilization is associated with lower overall costs.
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