ReviewThe Journal of arthroplasty2023
Lessons Learned From the Comprehensive Care for Joint Replacement Model at an Academic Tertiary Center: The Good, the Bad, and the Ugly.
Review in The Journal of arthroplasty, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed.
- Geographic Variability in Medicare Hospital Reimbursement for Primary Total Hip and Knee Arthroplasty Episodes of Care From 2013 to 2023.Arthroplasty today · 2026Article
- The Impact of Disease-Specific Care Certification on Total Medical Costs for Joint Replacement Surgeries.Healthcare (Basel, Switzerland) · 2025Article
- Preoperatively predicting failure to achieve the minimum clinically important difference and substantial clinical benefit for total knee arthroplasty patients using machine learning.Knee surgery & related research · 2025Article
- Declining Service Labor Rates for Total Hip and Total Knee Arthroplasty in Medicare Patients.Arthroplasty today · 2025Article
- Optimizing Quality Care within a Bundled Framework.Journal of the American Society of Nephrology : JASN · 2025Article
- Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis.Journal of orthopaedics · 2025Article
- Preoperatively predicting failure to achieve the minimum clinically important difference and the substantial clinical benefit in patient-reported outcome measures for total hip arthroplasty patients using machine learning.BMC musculoskeletal disorders · 2025Article
- Implementing value-based healthcare: a scoping review of key elements, outcomes, and challenges for sustainable healthcare systems.Frontiers in public health · 2025Article
- Reversal of the Halo Effect: Prolonged Participation in Comprehensive Care for Joint Replacement Negatively Impacts Revision Metrics.Arthroplasty today · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundOur institution participated in the Comprehensive Care for Joint Replacement (CJR) model from 2016 to 2020. Here we review lessons learned from a total joint arthroplasty (TJA) care redesign at a tertiary academic center amid changing: (1) CJR rules; (2) inpatient only rules; and (3) outpatient trends.
methodsQuality, financial, and patient demographic data from the years prior to and during participation in CJR were obtained from institutional and Medicare reconciled CJR performance data.
resultsDespite an increase in true outpatients and new challenges that arose from changing inpatient-only rules, there was significant improvement in quality metrics: decreased length of stay (3.48-1.52 days, P < .001), increased home discharge rate (70.2-85.5%, P < .001), decreased readmission rate (17.7%-5.1%, P < .001), decreased complication rate (6.5%-2.0%, P < .001), and the Centers for Medicare and Medicaid Services (CMS) Composite Quality Score increased from 4.4 to 17.6. Over the five year period, CMS saved an estimated $8.3 million on 1,486 CJR cases, $7.5 million on 1,351 non-CJR cases, and $600,000 from the voluntary classification of 371 short-stay inpatients as outpatient-a total savings of $16.4 million. Despite major physician time and effort leading to marked improvements in efficiency, quality, and large cost savings for CMS, CJR participation resulted in a net penalty of $304,456 to our institution, leading to zero physician gainsharing opportunities.
conclusionThe benefits of CJR were tempered by malalignment of incentives among payer, hospital, and physician as well as a lack of transparency. Future payment models should be refined based on the successes and challenges of CJR.
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