Hospital readmission rates and Medicare payments to nursing facilities dropped among Black patients who received a hip or knee replacement surgery after the introduction of Medicare's Comprehensive Care for Joint Replacement model, according to a new study from the Icahn School of Medicine at Mount Sinai Health System in New York City.
The final results of the study were published June 1 in The Journal of Bone & Joint Surgery. Researchers said they could not directly link the bundle design to the disparity reductions, but said it does offer a potential strategy to target racial disparities.
The study analyzed nationwide Medicare claims data for nearly 1.5 million hip or knee replacement surgeries performed from 2013 to 2018. About 5 percent of patients were Black. The CJR model launched in 2016.
Results before and after implementation of the model showed major differences in patient characteristics, outcomes and Medicare payments. Black patients specifically faced higher rates of health problems, received more blood transfusions, were in the hospital for longer and were more likely to be discharged to another institution instead of their home.
The CJR model led to reductions in how long patients were in the hospital, complication rate, hospital readmission rates within 90 and 180 days, discharge to institutional care, and Medicare payments to skilled nursing facilities. Black patients specifically had greater reductions in 90-day and 180-day hospital readmission rates and Medicare payments related to skilled nursing facilities.