For the ﬁrst time, CMS is making bundled payments mandatory for hospitals with the Comprehensive Care for Joint Replacement (CJR) model, set to begin April 1st. The program holds hospitals and their collaborators accountable for costs, complication rates, and quality of care for patients undergoing hip and knee replacements.
What is the purpose of CJR?
Hip and knee replacement surgeries are the most common procedures among Medicare patients, with hospitalizations alone costing more than $7 billion annually. With these patients receiving care from several providers, it is essential to coordinate care across the hospital and post-discharge environments.
CJR aims to enhance care coordination by holding approximately 800 hospitals in 67 geographic regions ﬁnancially accountable for a 90-day risk-window, including all post-acute costs. CMS will set a pre-determined target price for an episode of care. If the hospital’s spending exceeds this target, the facility pays the excess cost to CMS. In contrast, if the total episode cost is below the target, CMS reimburses the hospital the difference as a bonus.
What does CJR mean for PAC providers?
While CJR seems to impact only hospitals, the primary opportunity for hospitals to increase gain or decrease loss will occur in the post-acute care (PAC) setting. On average, 45% of all episode payments occur post-discharge. For this reason, hospitals are going to form networks and enter risk-share agreements with PAC providers that have proven to provide efficient, high-quality care. Specifically, hospitals will consider:
- Home Health Compare and Nursing Home Compare (Star ratings and quality metrics)
- Historical Medicare Payments
How Can PAC Providers Prepare?
To succeed under CJR and share in the rewards of the program, PAC providers must work towards better care coordination and transitions across settings. CipherHealth’s integrated engagement solutions help connect providers across the continuum, and in turn, reduce costs associated with complications and readmissions, improve quality of care, and enhance the care experience.
For more information on how we can help you to be a successful post-acute care collaborator under the CJR model, contact us today or download our overview.