Li Jun, Monti Yvonne, Ryan Andrew
Jun Li, PhD, is Assistant Professor, Public Administration and International Affairs, Syracuse University, Syracuse, NY;
Yvonne Monti, OTD, is Assistant Professor, School of Health Professions, Utica University, Utica, NY.
Am J Occup Ther. 2025 Jan 1;79(1). doi: 10.5014/ajot.2025.050736.
Medicare's Comprehensive Care for Joint Replacement (CJR) program rewards hospitals for reducing total Medicare spending. Despite the benefits of occupational therapy (OT) for patient outcomes and spending, little is known about how CJR affects hospital provision of acute occupational OT services.
Determine whether CJR changed acute OT provision and whether higher acute OT provision was associated with CJR rewards.
Cohort study with randomization.
Hospitals.
Patients covered by Medicare who were discharged after major joint replacement surgery (n = 1,006,938) in 722 hospitals randomly selected for treatment under CJR and 859 hospitals in the control group, before (July 2014-June 2015) and after (April 2016-December 2018) CJR in the United States.
National Medicare inpatient claims data were used to examine diagnoses and per-hospitalization acute OT provision (OT costs, patient receipt of OT, and OT share of hospitalization costs). CJR files were used to determine hospital rewards (CJR dollars per discharge).
CJR did not affect acute OT provision in terms of per-hospitalization OT costs, patient receipt of OT, or OT share of total hospitalization costs. Each additional dollar of OT spent by hospitals was associated with an increase of $1.99 CJR reward dollars (95% confidence interval [0.82, 3.16]).
These results indicate that hospitals did not increase acute OT as part of their improvement strategy under CJR, despite the potential for acute OT to yield financial returns on investment. Plain-Language Summary: Medicare's Comprehensive Care for Joint Replacement (CJR) bundled payment program rewards hospitals for low Medicare spending from hospitalization through 90 days postdischarge. Although occupational therapy (OT) improves patient-centered care and reduces Medicare spending, it is unknown whether hospitals modified (or targeted) acute OT services when treating older patients who were hospitalized for major joint replacement surgery under CJR. We used national Medicare data to characterize the variation in hospital use of acute OT and to identify how CJR affected acute OT use by hospitals. We then examined whether acute OT use was associated with financial returns on investment by hospitals in CJR. We found that acute OT use did not change under CJR, even though higher OT use was correlated with larger financial rewards for CJR hospitals. Future research should focus on quantifying the value-added of OT on patient outcomes and Medicare spending.
医疗保险的关节置换综合护理（CJR）计划对降低医疗保险总支出的医院给予奖励。尽管职业治疗（OT）对患者治疗效果和支出有益，但对于CJR如何影响医院提供急性职业OT服务却知之甚少。
确定CJR是否改变了急性OT的提供情况，以及更高的急性OT提供量是否与CJR奖励相关。
随机分组的队列研究。
医院。
在2014年7月至2015年6月（CJR实施前）和2016年4月至2018年12月（CJR实施后）期间，在美国722家被随机选择接受CJR治疗的医院以及859家对照组医院中，接受重大关节置换手术后出院的医疗保险覆盖患者（n = 1,006,938）。
使用国家医疗保险住院理赔数据来检查诊断情况和每家医院的急性OT提供情况（OT成本、患者接受OT治疗的情况以及OT在住院成本中的占比）。CJR文件用于确定医院奖励（每次出院的CJR美元数）。
就每次住院的OT成本、患者接受OT治疗的情况或OT在总住院成本中的占比而言，CJR并未影响急性OT的提供。医院每多花费1美元的OT费用，与CJR奖励增加1.99美元相关（95%置信区间[0.82, 3.16]）。
这些结果表明，尽管急性OT有可能带来投资财务回报，但医院在CJR下并未将增加急性OT作为其改进策略的一部分。通俗易懂的总结：医疗保险的关节置换综合护理（CJR）捆绑支付计划对从住院到出院后90天医疗保险支出较低的医院给予奖励。尽管职业治疗（OT）可改善以患者为中心的护理并降低医疗保险支出，但尚不清楚在CJR下，医院在治疗因重大关节置换手术住院的老年患者时是否调整（或针对）了急性OT服务。我们使用国家医疗保险数据来描述医院急性OT使用情况的差异，并确定CJR如何影响医院对急性OT的使用。然后，我们研究了急性OT的使用是否与CJR下医院的投资财务回报相关。我们发现，尽管急性OT使用量增加与CJR医院获得的更大财务奖励相关，但在CJR下急性OT的使用并未改变。未来的研究应侧重于量化OT对患者治疗效果和医疗保险支出的增值作用。
