The Provider Data on Comprehensive Care for Joint Replacement Model is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.
The Comprehensive Care for Joint Replacement (CJR) model encourages physicians, hospitals, and post-acute care providers to work together to improve quality of care for patients undergoing hip and knee replacement inpatient surgeries. This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.
The CJR model tracks two quality measures during an episode of care:
– Complication rate for hip/knee replacement patients for Hospital-level risk-standardized complication rate (RSCR) following Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA).
– Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, calculated as an HCAHPS Linear Mean Roll-Up Score.
The CJR model also encourages hospitals to voluntarily submit data on Patient-Reported Outcomes (PROs) for patients undergoing hip/knee replacements (THA/TKA PROs) and limited data on risk variables race and ethnicity, Body Mass Index (BMI) or weight and height, and patient health literacy.
Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2014, there were more than 400,000 procedures, costing more than $7 billion for the hospitalizations alone. Despite the high volume of these surgeries, quality and costs of care for these hip and knee replacement surgeries still vary greatly among providers. For instance, the rate of complications like infections or implant failures after surgery can be more than three times higher at some facilities than others, increasing the chances that the patient may be readmitted to the hospital. And, the average Medicare expenditure for surgery, hospitalization and recovery ranges from $16,500 to $33,000 across geographic areas. CMS has implemented the CJR model in 67 geographic areas, defined by metropolitan statistical areas (MSAs). MSAs are counties associated with a core urban area that has a population of at least 50,000. Non-MSA counties (no urban core area or urban core area of less than 50,000 population) were not eligible for selection.
The CJR model holds participant hospitals financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians and post-acute care providers. In the CJR model, beneficiaries retain their freedom of choice to choose services and providers. Physicians and hospitals are expected to continue to meet current standards required by the Medicare program. All existing safeguards to protect beneficiaries and patients remain in place.
In this dataset, the start and end measure dates for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) covers the period from 1st July 2016 to 30th June 2017 and complications measure cover the period from 1st April 2014 to 31st March 2017. The start and end measure dates for patient-reported outcomes covers the period from 1st September 2016 to 30th June 2017.