Care Joint Replacement (CJR) going into effect on April 2016
The bundled payment Comprehensive Care Joint Replacement (CJR) model was finalized on Nov. 16 by the Centers for Medicare & Medicaid Services (CMS) Innovation Center and will go into effect on April 1, 2016.
Purpose of this model:
According to CMS:
? The model will test bundled payment and quality measurement for hip and knee replacements and major leg procedures.
? To encourage hospitals, physicians and post-acute care providers to work together to improve quality and coordination of care throughout an entire episode of care.
? To create a health care system that provides better care, spends health care dollars more wisely and makes people healthier. It builds on measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.
? The health agency hopes that providers will be motivated to engage in a number of quality improvements, such as better care coordination and improved care transitions between medical settings.
? The episode of care model will follow the patient from surgery through recovery.
? The model?s goal is to give hospitals a financial incentive to work with physicians, home health agencies, skilled nursing facilities, and other providers to make sure beneficiaries get the coordinated care they need.
? Today, beneficiaries receive care from many providers and suppliers, with each having their own coordination efforts. This can lead to confusion and in some cases, multiple care plans and instructions for beneficiaries that conflict and can lead to re-hospitalizations and complications.
? Will help hospitals improve care delivery and care coordination by providing spending and utilization data and facilitating the sharing of best practices.
Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2014, there were more than 400,000 procedures costing more than $7 billion for the hospitalizations according to the records. According to CMS, despite the high volume of these surgeries, quality and costs of care for these hip and knee replacement surgeries still vary greatly among providers.
According to CMS, the rate of complications such as infections or implant failures after surgery can be more than three times higher at some facilities than others, increasing the chances that the patient may be readmitted to the hospital. The average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.