Abstract
Introduction
The Comprehensive Care for Joint Replacement (CJR) initiative was implemented to address the two most commonly billed inpatient surgical procedures, total hip and knee arthroplasty. The primary purpose of this manuscript is to review the economic implications of one institution's mandatory involvement in CJR in comparison to prior involvement in Bundled Payment for Care Improvement (BPCI).
Methods
The average cost per episode of care (EOC) was calculated using our institution's historical data. The target prices, projected savings or losses per EOC, and the projected annual savings for both BPCI and CJR were established and comparatively analyzed.
Results
The CJR target prices will decrease in comparison to BPCI target prices by: 24% for MS-DRG 469 without fracture, 22.8% for 469 with fracture, 26.1% for 470 without fracture, 27.7% for 470 with fracture; resulting in a reduction in savings per EOC by: 92.8% for MS-DRG 469 without fracture, 166.0% for 469 with fracture, 94.9% for 470 without fracture, 61.7% for 470 with fracture (Table 1). This institution's projected annual savings under CJR will decrease by 83.3%.
Conclusion
These results suggest that the margin for savings in CJR will be substantially reduced compared to those in BPCI. Hospitals resources previously devoted will have far less impact in CJR and hospitals new to CJR who have not made these investments previously, will require even greater resources for developing cost-reduction and quality control strategies to remain financially solvent.
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