Association Between Medicare’s Mandatory Joint Replacement Bundled Payment Program and Post–Acute Care Use in Medicare Advantage

Under bundled payment programs, such as Medicare’s Comprehensive Care for Joint Replacement (CJR) model, hospitals bear financial risk for posthospitalization care for beneficiaries in traditional fee-for-service Medicare. It is unknown whether participating hospitals change care patterns only for patients subject to the payment bundle or if changes spillover onto care for other patients undergoing joint replacement. Spillovers to Medicare Advantage (MA) patients would indicate that clinicians have a consistent approach to discharge planning regardless of payer^1,2 and would suggest Medicare’s payment reforms have had a broader societal effect.³

The CJR model was implemented in a random sample of communities and only includes patients with traditional Medicare who received a lower extremity joint replacement (LEJR). In prior evaluations of CJR and other LEJR bundled payment programs, spending reductions have primarily been driven by fewer discharges to institutional post–acute care settings.^4,5 We evaluated whether the reductions in institutional posthospitalization care observed in the first year of the CJR program among traditional Medicare patients were also observed among MA patients who underwent LEJR.