The Comprehensive Care for Joint Replacement (CJR) model is a program begun by CMS in April 2016 that aims to improve care and reduce costs for patients undergoing knee and hip replacement surgery. 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 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.
Hospitals with the lowest average episode costs tended to have higher Medicaid payor mixes and fewer total claims. Hospitals with the most episodes do generally have higher per-episode spending and lower Medicaid payor mixes. On average, the hospitals with the lowest costs reported a Medicaid payor mix of 41.5 percent, while the hospitals with the greatest number of CJR claims reported an average payor mix of 30.6 percent.
One may expect that the hospitals with the greatest number of CJR claims would have lower costs per episode than hospitals with fewer claims, as the former would likely be more accustomed to performing the procedures and therefore more cost-efficient. However, according to the following tables, this assumption would be incorrect. The Hospital for Special Surgery reported both the greatest number of CJR claims as well as the highest average cost per claim. Summit Medical Center, meanwhile, reported both the fewest number of CJR claims as well as the lowest average cost per claim. One explanation could be location: Summit is located in Oklahoma, while the Hospital for Special Surgery is located in New York. Region is a major contributing factor to procedure costs, as location influences everything from supply costs to providers’ salaries.
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