# Spillover Effects of Comprehensive Care for Joint Replacement (CJR) model

> **NIH AHRQ R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2021 · $378,159

## Abstract

Project Summary
In an effort to improve quality of care while controlling costs, Medicare is moving away from traditional fee-for-
service reimbursement to value-based payments. This shift may have significant ramifications beyond the
Medicare population if it leads to practice-wide changes that affect all patients. Understanding the implications
of these spillover effects on the larger health care system is critical for assessing the impacts of federal policy.
We propose to investigate the spillover effects by studying one of Medicare's key value-based payments, the
Comprehensive Care for Joint Replacement (CJR) program.
In April 2016, Medicare introduced the CJR program – its first mandatory bundled payment program – for its
patients undergoing hip and knee replacements (also called lower extremity joint replacements or LEJR). The
program holds hospitals accountable for the cost and quality of the LEJR episode, defined as the inpatient stay
and 90 days following hospital discharge. The CJR program was implemented in 67 randomly selected
metropolitan statistical areas (MSAs), allowing for a causal estimate of spillover effects.
Our long-term objective is to understand how innovative payment models for the Medicare population affect the
broader health care system. Our central hypothesis is that CJR catalyzes practice-wide changes, therefore
reducing overall health service use while maintaining the quality of care among Medicare Advantage and
commercially-insured LEJR patients. We also hypothesize that the magnitude of spillover effects decreased
when CJR participation became voluntary. Starting in January 2018, hospitals in 33 of the original 67 MSAs
had the option to continue with or withdraw from the CJR program.
This proposal has three specific aims. First, we aim to assess the spillover effects of CJR on health service use
related to LEJR. Second, we aim to assess the spillover effects of CJR on quality of care and expenditures
related to LEJR. Third, we aim to assess changes in the spillover effects of CJR when participation became
voluntary in 33 of the original 67 MSAs.
To accomplish these aims, we will use a claims database from the Health Care Cost Institute that includes 25%
of all Medicare Advantage and commercial insurance enrollees in the nation, and conduct difference-in-
differences analyses. The CJR program has the potential to affect care delivery and health care spending for
patients beyond its target group. Our proposal will provide critical information in assessing the impact of federal
policies on the health care system at large.

## Key facts

- **NIH application ID:** 10115657
- **Project number:** 5R01HS026457-03
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** HYUNJEE KIM
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $378,159
- **Award type:** 5
- **Project period:** 2019-06-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10115657

## Citation

> US National Institutes of Health, RePORTER application 10115657, Spillover Effects of Comprehensive Care for Joint Replacement (CJR) model (5R01HS026457-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10115657. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*