This week the CMS Innovation Center released a report, “CMS Innovation Center Tackles Implicit Bias,” which assessed three CMMI payment models, including the Comprehensive Care for Joint Replacement Model.


AAHKS advocacy partner Epstein Becker Green summarized the CJR report here, “confirming AAHKS’ historical comments to CMS that lack of risk adjustment in CJR likely drove selection bias against medically complex patients.” In addition, the report finds the following related to CJR:


  • Evaluation found that beneficiaries receiving joint replacements at participating hospitals while the CJR program was in effect were less medically complex than those receiving joint replacements at those same hospitals before the CJR implementation began. Beneficiaries receiving joint replacements in the CJR were also less likely to be dually eligible for Medicaid and Medicare than those not in CJR
  • Because earlier studies show that “compared with White patients, Black and low-income patients are more likely to be discharged to post-acute care following surgery” [which is associated with increased odds of 30-day hospital readmission and higher spending], an “opportunity for bias” exists in CJR as “providers could make fewer offers of joint replacement surgery to Black and low-income individuals in an effort to keep spending below the CJR target price and generate savings under the model”
  • CMS states that revising the CJR risk-adjustment formula to include dual-eligibility status beginning in 2022 (as AAHKS advocated for) is a step towards addressing this concern
  • CMS is collecting data to determine how the revised risk-adjustment, or other factors, may impact patient selection and potential “bias based on patient sociodemographic characteristics”


Read the Health Affairs Forefront article here.

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