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Related Experiment Video

Updated: Oct 17, 2025

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty
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Patient selection in the Comprehensive Care for Joint Replacement model.

Hyunkyu Ko1, Brook I Martin1, Richard E Nelson2,3

  • 1Department of Orthopaedics, Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA.

Health Services Research
|October 6, 2021
PubMed
Summary

The Comprehensive Care for Joint Replacement (CJR) program reduced episode costs and readmissions. However, CJR hospitals also showed evidence of avoiding older patients, suggesting potential risk selection.

Keywords:
Centers for Medicare and Medicaid ServicesComprehensive Care for Joint Replacement modelMedicarebundled payment programpatient selection

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Area of Science:

  • Health economics
  • Healthcare policy
  • Orthopedic surgery

Background:

  • The Comprehensive Care for Joint Replacement (CJR) program aimed to reduce costs and improve quality for joint replacement surgeries.
  • Understanding the program's impact on hospital behavior, including patient selection and cost management, is crucial.

Purpose of the Study:

  • To evaluate if the CJR program incentivized hospitals to select lower-risk patients.
  • To assess if CJR led to reduced 90-day episode-of-care costs and improved quality.
  • To determine if cost reductions were greater in the second year with downside financial risk.

Main Methods:

  • Analysis of Medicare fee-for-service claims (2013-2017) for patients aged 65+ undergoing hip or knee replacement.
  • Comparison of CJR-participating hospitals (785) with non-participating hospitals (962) using a difference-in-differences approach.
  • Focused on elective admissions, excluding hospitals with prior Bundled Payments for Care Improvement (BPCI) participation.

Main Results:

  • CJR hospitals achieved greater 90-day episode-of-care cost reductions (-$902), mainly from skilled nursing facility savings.
  • Significant reductions in 90-day readmission rates (-3.9%) were observed in CJR hospitals.
  • CJR hospitals preferentially avoided older patients (85+ years; -5.9%) and Black patients (-7.0%).

Conclusions:

  • CJR participation was linked to modest cost reduction and decreased readmissions.
  • Evidence suggests CJR hospitals engaged in preferential patient selection, avoiding higher-risk older individuals.
  • The program's effects on cost reduction were more pronounced in the second year, coinciding with downside financial risk implementation.