Overlap Between Medicare’s Comprehensive Care for Joint Replacement Program and Accountable Care Organizations

Abstract Background Overlap between Medicare’s Comprehensive Care for Joint Replacement (CJR) and accountable care organizations (ACOs) may result in positive or negative synergies. In this study, we describe the overlap between the programs at the beneficiary and hospital levels. Methods We conducted a retrospective study of patient and hospital characteristics using data from 2016 Medicare claims, the US Census Bureau, the American Hospital Association annual survey, Hospital Compare, and the Centers for Medicare & Medicaid Services Improving Medicare Post–Acute Care Transformation file. On the beneficiary level, we conducted two comparisons: 1) among patients who received joint replacement at CJR hospitals, ACO patients (Overlap) versus not (CJR-only) and 2) among patients who received joint replacement elsewhere, ACO patients (ACO-only) versus not (Neither). On the hospital level, we compared hospitals in the top quartile of overlap rate (High Overlap) versus those in the bottom three (Low Overlap). Results We studied 14,519 Overlap, 38,972 CJR-only, 26,872 ACO-only, and 68,945 Neither beneficiaries. Compared to CJR-only patients, the Overlap group was less likely to be older than 85, of Black race, of low socioeconomic status, and burdened with clinical complications. Similar results were observed when the ACO-only group was compared to the Neither group. Compared to Low Overlap hospitals, High Overlap ones were more likely to be non-profit and less likely to be safety-net. Conclusions CJR-ACO overlap is associated with differences in beneficiary and hospital characteristics, which raises key issues for providers and policymakers.