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To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode-based payment program for knee and hip replacement surgery, affected patient-reported measures of quality.Surveys of Medicare fee-for-service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for MedicareMedicaid Services, and the Area Health Resource Files.In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower-extremity joint replacements surgery. The control group included 47 high-payment MSAs randomly assigned as controls. We estimated risk-adjusted differences in self-reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group.We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents.CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post-acute care stay). On a 100-point scale, differences ranged from -2.6 points (p 0.01) for help needed bathing to -1.7 points (p 0.05) for help needed using the toilet. However, differences in eight measures of self-reported functional status approximately 90-120 days after hospital discharge were not statistically significant, ranging from -1.1% (p = 0.087) to 0.7% (p = 0.437).CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.

RESEARCH OBJECTIVE: The Comprehensive Care for Joint Replacement (CJR) model is intended to encourage participant hospitals to reduce Medicare payments by coordinating care with the physicians, post‐acute care (PAC) providers, and other providers involved in an episode of care for a lower extremity joint replacement (LEJR), which comprises the surgery plus the services provided in the 90 days after hospital discharge. Previous studies have documented reductions in institutional PAC attributable to the model.(1) The shift towards less intensive PAC could affect patient experiences and recovery. We surveyed Medicare fee‐for‐service (FFS) beneficiaries after LEJR surgery to document their self‐reported functional status, pain, satisfaction with care management and overall recovery, care transitions, and dependence on caregivers for help with activities of daily living. These patient‐reported outcomes are important indicators of quality that cannot be measured using secondary data. STUDY DESIGN: In 2018, participation in CJR was mandatory for hospitals that that did not meet rural or low‐volume exemptions, and were located in 34 randomly‐selected, historically high‐payment metropolitan statistical areas (MSAs). We surveyed a census of Medicare FFS beneficiaries who had LEJR surgery in mandatory CJR hospitals, and those who had LEJR surgery in hospitals within 47 high‐payment MSAs randomly assigned to the control group. Patients received the survey approximately 90 to 120 days after hospital discharge. We estimated risk‐adjusted differences between CJR and control respondents. POPULATION STUDIED: We sampled beneficiaries who had LEJR surgery in March, April, August or September 2018 from the CJR group (12,478 beneficiaries) and the control group (13,137 beneficiaries). Response rates for the survey were similar for the CJR and control groups (67.6% and 68.6%, respectively). PRINCIPAL FINDINGS: The CJR model did not have a significant impact on patient‐reported functional status, pain, satisfaction with care management or satisfaction with overall recovery. However, CJR respondents were 1.2 percentage points less likely to report that they received the right amount of care in the two weeks after hospital discharge than control respondents (p