For the ﬁrst time, CMS is making bundled payments mandatory for hospitals with the Comprehensive Care for Joint Replacement (CJR) model. This program, set to begin on April 1, 2016, takes the ﬁrst generation of bundled payment programs to a new level by holding hospitals accountable for not only costs, but also complication rates, quality of care, and patient experiences.
What is 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. The CJR model addresses this need by holding hospitals in 67 geographic regions ﬁnancially accountable for entire episodes of care – the patient’s procedure and up to 90 days of post-discharge care.
How does it work?
Based on hospital-specific and region-specific data, 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. Even if episodic costs are below the target, however, hospitals will not receive a bonus if they experience high rates of surgery complications or readmissions, or if they cannot maintain strong HCAHPS scores.
How to Prepare for CJR
To succeed under the CJR model, hospital executives and clinical leaders must take proactive steps to reduce costs and readmissions, and improve the patient experience. Organizations should have systems in place to coordinate care across providers, follow up with each patient after an operation or hospital visit, and resolve any patient issues quickly and effectively.
To learn more about the steps your organization can take to capitalize on the program’s financial gains, download our guide on orthopedic patient follow up, or contact us today.