Reduced Spending With Mandatory Bundled Payments for Joint Replacements

Launched in 2016, the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model provides a wide-scale, mandatory, episode-based bundled payment program for lower extremity joint replacement.¹ This alternative payment model incentivizes hospitals, physicians, and postacute care from initial hospitalization through 90 days of recovery to reduce episodic costs without negatively affecting outcomes.¹ Market-level randomization of the CJR program to an array of metropolitan statistical areas forms a natural test-bed for health policy experiments, including the well-designed, intention-to-treat, difference-in-differences study in this issue of JAMA Internal Medicine.² The study provides a timely analysis of how the CJR program is progressing toward its goal of slowing Medicare spending without sacrificing quality.^1,3,4 We comment on the assessment of differences in spending, use, quality, and patient characteristics between hospitals participating in CJR with non-CJR institutions during the first 18 months of the program.