What is CCJR?
In line with the Obama Administration’s efforts to provide high-quality care while reducing costs, CMS recently announced an initiative to implement bundled payments for hip and knee replacement surgeries, the most common surgeries among Medicare patients. This program, known as Comprehensive Care for Joint Replacement (CCJR), takes voluntary programs like the Bundled Payments for Care Improvement (BPCI) initiative to a whole new level by not only making it mandatory, but also by covering only two specific conditions.
How does the program work?
All hospitals across 75 metropolitan areas not already participating in BCPI would be required to participate in CCJR. These hospitals would be held financially accountable for an entire “episode” of care: the patient’s procedure, as well as 90 days of post-discharge care. The total episode cost will be compared to a pre-determined target price, the amount CMS believes an episode should cost based on hospital-specific and region-specific data. If total episode spending surpasses the target price, the hospital pays the excess cost to CMS. Should a hospital surpass the target price, they are not required to begin absorbing these losses until the second year of CCJR.
In contrast, if the total episode cost falls below the target price, CMS reimburses the hospital the difference as a bonus. That said, it is important to know that if hospitals do not maintain strong HCAHPS scores, they will not be eligable to receive the bonus, despite falling below the target price. The projected goal is to promote population health and provide quality care at a cost-effective price through care coordination efforts.
When will it begin?
CCJR is projected to launch on January 1, 2016 and last for five years. CMS is accepting comments from the public until September 8, 2015.
How can hospitals prepare?
There are several steps hospitals can take to prepare for this program. First and foremost, it’s important to define current care patterns and note areas for improvement by using data analysis. Based on insights, hospitals should outline future care delivery and clinical needs that are instrumental in maintaining high quality, cost efficient care. Finally, hospitals should implement changes in inpatient care, care transitions, and/or post-discharge care to guarantee efficient care management during episodes.