Did CJR make a difference? 4 things to know on Medicare total joint replacement readmissions

A new study published in the Journal of Arthroplasty examines whether healthcare reform's Comprehensive Care for Joint Replacements initiative reduced costs associated with primary total joint replacements and outlined the factors most notably contributing to those costs.


The study examined 1.6 million patients who underwent primary total hip and total knee replacements in a 100-percent Medicare inpatient dataset. The patients underwent surgery between 2010 and 2014. Study authors found:

1. The 90-day readmission rate dropped by 2 percent for total hip replacements and by 4 percent for total knee replacements. However, the cost of readmissions didn't change significantly over time.

2. Five variables were identified as most associated with the cost for 90-day hip replacement readmissions:

• The nature of the readmission — medical or procedure related
• Length of stay
• The hospital's teaching status
• Discharge disposition
• Total joint replacement volume

3. The five top variables associated with the cost of 90-day readmissions for total knee replacement were:

• Length of stay
• Hospital's teaching status
• Discharge disposition
• Gender
• Age

4. The study authors concluded readmission costs didn't have a significant decrease after implementing healthcare reform legislation. "Instead, we found that clinical and hospital factors were among the most important cost drivers."

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