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Bundled payment model reduces health disparities for Black patients

Readmission risk decreased about 3% for Black patients, and stayed roughly the same for Hispanic and white patients.

Jeff Lagasse, Associate Editor

A new nationwide model of care for hip and knee joint replacements appears to reduce disparities in health outcomes for Black patients, according to new research led by Oregon Health and Science University.

Researchers examined health outcomes for about 700,000 patients who underwent joint replacement procedures through Medicare between 2013 and 2017. The study examined differences in outcomes before and after April 2016, when Medicare adopted a model called Comprehensive Care for Joint Replacement, a bundled payment model designed to reduce spending and improve outcomes for all joint replacement patients.

The review is published by the journal JAMA Network Open.

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The retrospective study examined three key metrics: spending, discharges to institutional post-acute care and hospital readmission. It compared outcomes for patients self-identified as white, Black and Hispanic.

Taken together, the results showed improved outcomes for Black patients and mixed results for Hispanic patients compared with those who are white.

Although Black patients were discharged to institutional post-acute care more than white patients, the gap narrowed under the new bundled payment model. Readmission risk decreased about 3% for Black patients under the new model, and stayed roughly the same for Hispanic and white patients.

The decreased readmission rate for Black patients, combined with lower rates of institutional post-acute care, translate to better overall care.

The bundled payment plan was enacted in April 2016 to reduce cost and improve care for the single most common inpatient procedure for Medicare beneficiaries. Hip and knee replacements alone account for 5% of total Medicare inpatient spending.

The OHSU-led retrospective study is the first to gauge the plan's comparative effect on Black and Hispanic patients, who have historically had worse outcomes compared with white patients.

Overall, the study found substantially reduced use of institutional post-acute care for all groups.


The CJR Model was established through notice and comment rulemaking, and began on April 1, 2016. The model, which is currently scheduled to end on December 31, aims to reduce expenditures while preserving or enhancing quality of care by supporting better and more efficient care for beneficiaries undergoing hip and knee replacements, also called lower extremity joint replacements or LEJR.

The proposed rule, issued in February, aims to change certain aspects of the CJR Model, including incorporating outpatient hip and knee replacements into the episode of care definition, the target price calculation, the reconciliation process, the beneficiary notice requirements, gainsharing caps, and the appeals process.

Twitter: @JELagasse
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