Table 2.
Episode cost summaries for lower extremity joint replacement (LEJR) among the CMS, HVHC, and Mayo Clinic populations (2013) as grouped according to the CMS Comprehensive Care for Joint Replacement (CJR) program
| CMS LEJR population (N = 363 621) | HVHC LEJR subpopulation (N = 4881) | Mayo LEJR subpopulation (N = 918) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 20th percentile | Median | 80th percentile | 20th percentile | Median | 80th percentile | 20th percentile | Median | 80th percentile | |
| MS‐DRG 470, No HF | $17 437 | $20 331 | $28 663 | $16 181 | $19 565 | $28 114 | $14 624 | $17 288 | $24 920 |
| MS‐DRG 470, HF | $27 500 | $37 005 | $48 284 | $20 100 | $27 825 | $42 608 | $22 887 | $29 941 | $41 914 |
| MS‐DRG 469, No HF | $28 058 | $36 915 | $50 646 | $26 879 | $36 802 | $52 594 | $23 932 | $31 058 | $50 281 |
| MS‐DRG 469, HF | $39 593 | $49 710 | $63 356 | $36 181 | $57 153 | $72 098 | $35 968 | $50 504 | $65 607 |
| Overall | $17 790 | $21 818 | $33 146 | $16 276 | $19 808 | $28 807 | $14 672 | $17 881 | $26 097 |
CMS, Centers for Medicare and Medicaid Services; HF, hip fracture; HVHC, high value healthcare collaborative; MS‐DRG, Medicare severity‐diagnosis related group.
MS‐DRG 470: Episodes billed under “Major Joint Replacement or Reattachment of Lower Extremity Without Major Complication or Comorbidity (MCC).”
MS‐DRG 469: Episodes billed under “Major Joint Replacement or Reattachment of Lower Extremity With Major Complication or Comorbidity (MCC).”