Effect of CJR episode of care definition on hospital performance

Editor's Note

Comparing the Comprehensive Care for Joint Replacement (CJR) program’s broad definition of a patient’s episode of care (ie, initial hospitalization until 90 days after discharge) with a clinically narrow definition of an episode of care, researchers found that hospital performance was consistent no matter which definition was used.

The average 90-day payment difference between the two types of episodes of care was small (mean $452).

The findings suggest that the broad definition of an episode of care used by Medicare will not unintentionally penalize hospitals that treat patients with multiple medical conditions because 90-day readmissions resulting from conditions unrelated to the joint replacement are infrequent, the authors say.

Importance Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization until 90 days after hospital discharge (ie, the episode of care). It is not known whether unrelated expenditures resulting from this "broad" definition of an episode of care will affect participating hospitals' average episode-of-care payments.