New Jersey's joint replacement bundle slashes lengths of stay — 4 study insights

Early findings suggest New Jersey's Comprehensive Care for Joint Replacement bundled payment program reduces length of stay for Medicare patients.

The New Jersey Hospital Association's Center for Health Analytics, Research and Transformation analyzed the discharge status of 102,249 patients. Patients came from the following three hospital cohorts:

  • 67,516 from hospitals participating in the CJR bundle
  • 18,277 from hospitals participating in the Bundled Payment for Care Improvement program
  • 16,456 from hospitals that didn't participate in either program

The state required 38 New Jersey hospitals to participate in CJR in 2016.

Researchers found that:

1. Length of stay decreased from 3.2 to 2.6 days in CJR hospitals, from two to 1.7 days in BPCI hospitals, and from 2.9 to 2.4 days in non-participating hospitals.

2. CJR hospitals drastically cut discharges to skilled nursing facilities from 45 percent to 26 percent. These hospitals also increased discharges with home health assistance from 26 percent to 52 percent.

3. BPCI facilities discharged more patients to their homes with self-care from 29 percent to 60 percent, and decreased the number of patients discharged to their homes with health assistance from 50 percent to 23 percent.

4. Nonparticipating hospitals also discharged more patients to their homes with self-care from 28 percent to 46 percent.

While the researchers noted decreases in length of stay, they said they need more time to investigate several other findings, including what type of setting complex patients receive their follow-up care at and the functional and emotional status of patients.

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