Next Steps

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Doctor helping a patientWhile it is encouraging that nearly two-thirds of New Jersey’s CJR hospitals are anticipated to have a quality score high enough to earn a reconciliation payment, it is impossible to look at the data from a patient-centered perspective in the aggregate for hospitals that are submitting the voluntary data. This area of inquiry is important because the success of CJR, or any bundling initiative, should not be measured solely based on changes in utilization patterns and resources expended. Functional and emotional status of patients within the episode timeframe and subsequent to the end of the episode are important markers of impact for the long term.

For example, it would be important to know the functional ability of patients who were in CJR versus those who were not, based on the setting to which they were discharged from their inpatient stay. Also, the utilization of additional Medicare-funded services after the end of the episode (physician visits, outpatient rehabilitation services, skilled nursing facility, surgical procedures related to the original joint replacement surgery) related to discharge disposition would be important to understand.

Further, none of the data currently being collected directly measures social determinants of health such as food insecurity, adequacy of housing, neighborhood safety, financial security, social isolation, accessibility of transportation, interpersonal violence, etc. These factors are known to impact health and well-being of Medicare beneficiaries, as well as how frequently these individuals use healthcare services. While not directly related to the joint replacement procedure, these factors could have an adverse impact on the ability of the beneficiary to follow through on rehabilitation programs, follow-up medical appointments and correct adherence to medication regimens, among other activities.

The CJR mandatory bundling program could provide important insights into how future Medicare reimbursement will be designed for both fee-for-service and managed care enrollees. However, any evaluation of CJR must include a consumer-focused perspective to identify the true quality of care outcomes along with all of the utilization and financial metrics used to determine whether the model has been successful.