Safety-net hospital performance under Comprehensive Care for Joint Replacement

Area of Science:

• Health policy research
• Healthcare economics
• Bundled payment models

Background:

• Medicare's Comprehensive Care for Joint Replacement (CJR) is a mandatory bundled payment model aimed at improving joint replacement care.
• Safety-net hospitals (SNHs) serve vulnerable populations and may face unique challenges in value-based care programs.

Purpose of the Study:

• To evaluate the progress of SNHs in the CJR program from 2016-2020.
• To identify factors contributing to SNHs' success or challenges within the CJR model.

Main Methods:

• Analysis of secondary data from Centers for Medicare and Medicaid Services (CMS) and American Hospital Association.
• Utilized dominance analysis on ordinary least squares regression to assess predictors of financial performance changes.

Main Results:

• SNHs demonstrated less success in meeting episode spending targets compared to overall CJR hospitals.
• Hospital-specific factors were more influential than socioeconomic factors in explaining SNHs' financial progress.
• Nurse staffing levels did not significantly impact financial performance across CJR hospitals.

Conclusions:

• The current CMS spending target formula may not adequately address financial disparities experienced by SNHs.
• Further adjustments to payment models may be necessary to ensure equitable performance for SNHs in bundled payment programs.