Caroline P. Thirukumaran (
Laurent G. Glance is vice chair for research and a professor in the Department of Anesthesiology and Department of Public Health Sciences, University of Rochester.
Health Aff (Millwood). 2019 Feb;38(2):190-196. doi: 10.1377/hlthaff.2018.05264.
The Comprehensive Care for Joint Replacement (CJR) model introduced in 2016 aims to improve the quality and costs of care for Medicare beneficiaries undergoing hip and knee replacements. However, there are concerns that the safety-net hospitals that care for the greatest number of vulnerable patients may perform poorly in CJR. In this study we used Medicare's CJR data to evaluate the performance of 792 hospitals mandated to participate in the first year of CJR. We found that in comparison to non-safety-net hospitals, 42 percent fewer safety-net hospitals qualified for rewards based on their quality and spending performance (33 percent of safety-net hospitals qualified, compared to 57 percent of non-safety-net hospitals), and safety-net hospitals' rewards per episode were 39 percent smaller ($456 compared to $743). Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years. Medicare and hospital strategies such as those that reward high-quality care for vulnerable patients could enable safety-net hospitals to compete effectively in CJR.
2016 年引入的综合关节置换护理（CJR）模式旨在提高 Medicare 受益人的髋关节和膝关节置换护理的质量和成本。然而，有人担心为数量最多的弱势患者提供护理的医疗保障网医院在 CJR 中的表现可能不佳。在这项研究中，我们使用 Medicare 的 CJR 数据来评估 792 家被强制参与 CJR 第一年的医院的表现。我们发现，与非医疗保障网医院相比，符合奖励标准的医疗保障网医院比例低了 42%（符合条件的医疗保障网医院占 33%，而非医疗保障网医院占 57%），每例的奖励金额低了 39%（456 美元对 743 美元）。如果这种绩效趋势持续下去，医疗保障网医院在未来几年面临的罚款风险将会增加。医疗保险和医院策略，如为弱势患者提供高质量护理的奖励措施，可以使医疗保障网医院在 CJR 中有效地竞争。
