IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0319582.html

The spillover effects of Medicare’s comprehensive care for joint replacement (CJR) model in California

Author

Listed:
  • Narae Kim
  • Mireille Jacobson

Abstract

The Comprehensive Care for Joint Replacement (CJR) model, a bundled Medicare payment for lower extremity joint replacement (LEJR), was initially randomized across the United States, providing a unique opportunity to study the broad impact of this alternative payment model. This study aimed to determine the spillover effects of the CJR model on older patients in California covered outside of the traditional Medicare program. The study analyzed hospitalizations for hip and knee joint replacement in California between January 2014 and December 2017 from the California Patient Discharge Dataset. The study used event study and difference-in-differences models to estimate changes in discharge-related outcomes in hospitals in treated and control areas before versus after CJR implementation (April 2016). Main outcomes were hospital length of stay and home discharge rates. All LEJR patients admitted to the treated or control hospitals were included in the study regardless of their primary payers. Of 312,914 analyzed LEJR hospitalizations (mean [SD] age, 68.3 [11.3] years; 189,575 [60.6%] women; 15,374 [4.9%] black), 113,590 (36.3%) were covered by traditional Medicare (TM), 83,277 (26.6%) were covered by Medicare Advantage (MA), and 116,047 (37.1%) were without Medicare coverage. After program implementation, TM and non-Medicare patients in treated hospitals experienced reductions in length of stay (-4.0% & -1.0%, p

Suggested Citation

  • Narae Kim & Mireille Jacobson, 2025. "The spillover effects of Medicare’s comprehensive care for joint replacement (CJR) model in California," PLOS ONE, Public Library of Science, vol. 20(4), pages 1-11, April.
    • Handle: RePEc:plo:pone00:0319582
    DOI: 10.1371/journal.pone.0319582
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0319582
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0319582&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0319582?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. A. Colin Cameron & Jonah B. Gelbach & Douglas L. Miller, 2008. "Bootstrap-Based Improvements for Inference with Clustered Errors," The Review of Economics and Statistics, MIT Press, vol. 90(3), pages 414-427, August.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Friedrich, Sarah & Pauly, Markus, 2018. "MATS: Inference for potentially singular and heteroscedastic MANOVA," Journal of Multivariate Analysis, Elsevier, vol. 165(C), pages 166-179.
    2. Sandy Fréret & Denis Maguain, 2017. "The effects of agglomeration on tax competition: evidence from a two-regime spatial panel model on French data," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 24(6), pages 1100-1140, December.
    3. Francesco Berlingieri & Matija Kovacic, 2025. "Health and relationship quality of sexual minorities in Europe," Journal of Population Economics, Springer;European Society for Population Economics, vol. 38(1), pages 1-39, March.
    4. Cantoni, Enrico & Gazzè, Ludovica & Schafer, Jerome, 2021. "Turnout in concurrent elections: Evidence from two quasi-experiments in Italy," European Journal of Political Economy, Elsevier, vol. 70(C).
    5. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    6. Corno, Lucia & Voena, Alessandra, 2023. "Child marriage as informal insurance: Empirical evidence and policy simulations," Journal of Development Economics, Elsevier, vol. 162(C).
    7. Wissmann, Daniel, 2020. "Finally a Smoking Gun," Discussion Papers in Economics 73026, University of Munich, Department of Economics.
    8. Ilhom Abdulloev & Ira N Gang & Myeong-Su Yun, 2014. "Migration, Education and the Gender Gap in Labour Force Participation," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 26(4), pages 509-526, September.
    9. Marcel Fafchamps & Julien Labonne, 2017. "Do Politicians’ Relatives Get Better Jobs? Evidence from Municipal Elections," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 33(2), pages 268-300.
    10. Silverio-Murillo, Adan & Hoehn-Velasco, Lauren & Rodriguez Tirado, Abel & Balmori de la Miyar, Jose Roberto, 2021. "COVID-19 blues: Lockdowns and mental health-related google searches in Latin America," Social Science & Medicine, Elsevier, vol. 281(C).
    11. Bobonis, Gustavo J. & Morrow, Peter M., 2014. "Labor coercion and the accumulation of human capital," Journal of Development Economics, Elsevier, vol. 108(C), pages 32-53.
    12. Hossain, Marup & Songsermsawas, Tisorn, 2025. "Adapting to Thrive: Training and Access to Finance to Reduce Climate Vulnerability Among Smallholder Farmers in Nepal," 2025 AAEA & WAEA Joint Annual Meeting, July 27-29, 2025, Denver, CO 361170, Agricultural and Applied Economics Association.
    13. Manasvi Sharma, 2024. "Ethnic fertility and exposure to armed conflict: the case of Sri Lanka," Review of Economics of the Household, Springer, vol. 22(4), pages 1317-1351, December.
    14. Galletta, Sergio & Jametti, Mario, 2015. "How to tame two Leviathans? Revisiting the effect of direct democracy on local public expenditure in a federation," European Journal of Political Economy, Elsevier, vol. 39(C), pages 82-93.
    15. Hagemann, Andreas, 2019. "Placebo inference on treatment effects when the number of clusters is small," Journal of Econometrics, Elsevier, vol. 213(1), pages 190-209.
    16. Görlitz, Katja & Penny, Merlin & Tamm, Marcus, 2022. "The long-term effect of age at school entry on cognitive competencies in adulthood," Journal of Economic Behavior & Organization, Elsevier, vol. 194(C), pages 91-104.
    17. Nicolas Jacquemet & Adam Zylbersztejn, 2014. "What drives failure to maximize payoffs in the lab? A test of the inequality aversion hypothesis," Review of Economic Design, Springer;Society for Economic Design, vol. 18(4), pages 243-264, December.
    18. David Roodman & James G. MacKinnon & Morten Ørregaard Nielsen & Matthew D. Webb, 2019. "Fast and wild: Bootstrap inference in Stata using boottest," Stata Journal, StataCorp LLC, vol. 19(1), pages 4-60, March.
    19. Ellis, Jimmy R. & Gershenson, Seth, 2016. "LATE for the Meeting: Gender, Peer Advising, and College Success," IZA Discussion Papers 9956, IZA Network @ LISER.
    20. Anna Sokolova, 2023. "Marginal Propensity to Consume and Unemployment: a Meta-analysis," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 51, pages 813-846, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0319582. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.