GULF BREEZE — Dr. G. Daxton Steele, an orthopaedic surgeon and hip and knee replacement specialist at Andrews Institute for Orthopaedics & Sports Medicine, recently traveled to Washington D.C. with representatives from the American Association of Hip and Knee Surgeons to speak with congressional representatives about the Comprehensive Care for Joint Replacement model.
The CJR payment model, which was initiated on April 1, 2016, is a pilot program through the Center for Medicare Services that incentivizes hospitals and physicians to manage the cost of care for inpatient hip and knee replacement surgeries. Escambia and Santa Rosa counties are among 67 geographic areas where CMS has implemented the model.
“Our main agenda for this trip was to start a dialogue about improving patient access for hip and knee replacement surgeries,” Steele said. “Overall, (CJR) has been positive; we definitely think it has improved patient care. The program has really helped to reduce the cost of total joint surgeries and helped reduce unnecessary expenses.
“However, it has created a slight vacuum, in that it has also incentivized physicians to select patients that are less likely to have complications.”
While groups of patients with modifiable problems like obesity, smoking or uncontrolled diabetes can become candidates for hip and knee replacement surgeries after addressing those issues, there is still a group of patients with permanent problems, and they are not receiving the same access to care through CJR, according to Andrews Institute.
One group with high risk factors includes organ transplant patients.
“Patients with a heart or lung transplant are on medications that are notorious for causing hip and knee arthritis,” Steele said. “They have a much higher risk than the average patient for getting an infection because of their transplant medications. The patient and I have to make a decision on best options. While we can move forward with the joint replacement surgery, there is a higher risk for complications.”