OBJECTIVES

: The Centers for Medicare and Medicaid Services (CMS) initiated the Comprehensive Care for Joint Replacement Model (CJR) to improve outcomes through a bundled payment model. On October 1, 2017, CMS released new ICD-10 codes which apply to Oxidized Zirconium bearing surface of hip and knee implants. The objective of this study was to compare clinical outcomes and costs of Oxidized Zirconium versus non-Oxidized Zirconium hip and knee implants within the CJR 90-day episode of care.

METHODS

: Medicare Fee-For-Service (FFS) Standard Analytic Files (SAF) were used to construct hip and knee (MS-DRG 469 or 470) 90-day episodes of care initiating between Q4 2017 and Q1 2018. The study population included Medicare FFS patients continuously enrolled in Medicare Parts A and B for the 6-month period prior to the episode. The results of this analysis were not risk adjusted for differences in patient characteristics.

RESULTS

: 7,229 episodes used Oxidized Zirconium and 204,092 episodes used non-Oxidized Zirconium bearing surface. Oxidized Zirconium patients had lower rates of discharge to skilled nursing facilities (SNFs), lower rates of 30-day all cause readmissions (3.06% vs 4.61%), and lower rates of 90-day all cause readmissions (5.49% and 7.72%). Oxidized Zirconium episodes showed lower average costs of $2,034 per episode ($18,290 vs. $20,324), attributed to lower use of SNFs, fewer related hospital readmissions, and fewer days in inpatient rehabilitation.

CONCLUSIONS

: Oxidized Zirconium implants were associated with lower costs and fewer readmissions across 90-day episodes evaluated. Providers should consider this evidence in selecting the type of implant bearing surface for hip and knee replacements used to improve performance and lower costs under the CJR model.