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Invited Commentary
June 3, 2019

Reduced Spending With Mandatory Bundled Payments for Joint Replacements

Author Affiliations
  • 1UK Harkness Fellow in Health Care Policy & Practice, The Commonwealth Fund, The University of Texas at Austin
  • 2Value Institute for Health and Care, Dell Medical School, The University of Texas at Austin
  • 3Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin
JAMA Intern Med. 2019;179(7):932-933. doi:10.1001/jamainternmed.2019.0486

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.

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