Implementation of the comprehensive care for joint replacement model: A post-acute physical therapy case report

Background: The Centers for Medicare and Medicaid services has specifically targeted total joint replacements with a retrospective bundled payment program called the Comprehensive Care for Joint Replacement (CJR) model to improve collaboration between providers and decrease costs associated with the surgery and subsequent rehabilitation. The purpose of this report is to describe the physical therapy post-acute episode of care of a patient receiving services under the CJR model and illustrate the impact of facility policy changes on physical therapy service delivery, length of stay, cost of care, and patient outcomes in a post-acute environment. Case Description: The patient was a 78-year-old woman who underwent an elective total knee arthroplasty (TKA). She had moderate mobility impairments (total activities of daily living [ADL] score of 6) and was a high fall risk as scored by the Physical Mobility Scale and Tinetti Mobility Test, respectively. Physical therapy interventions focused on exercises to decrease activity limitations and participation restrictions. Outcomes: The patient demonstrated significant improvements in physical function after 22 total physical therapy visits spanning her Skilled Nursing Facility and subsequent outpatient treatment resulting in an intrafacility cost reduction of 52%. Compared with the average number of visits and costs for post-acute care following a TKA, this patient's care, under the CJR model, involved less cost and required fewer visits. Conclusions: This case report supports some of the proposed benefits of the CJR model for Medicare beneficiaries undergoing TKA.