The Centers for Medicare & Medicaid Services (CMS) is effectively implementing a strategy to shift Medicare Fee-for-Service (FFS) payments to alternative reimbursement models. CMS proposed the first mandatory bundled payment model, i.e. the Comprehensive Care for Joint Replacement Model (CJR) in July as a 5-Year Program CY2016-2020.
CJR covers Fee-for-Service Medicare beneficiaries discharged under MS-DRG 469 and 470 (Lower Extremity Joint Replacement (LEJR) procedures). The proposed bundle will cover all related Medicare Part A and Part B services across the episode of care, which CMS defines as beginning at inpatient admission through 90 days post-discharge.
As proposed, the CJR model applies to hospitals in 75 designated Metropolitan Statistical Areas (MSAs). Only hospitals participating in Phase 2 of the Bundled Payments for Care Improvement (BPCI) initiative are exempt from the mandatory CJR program. The Bundles are retrospective (Revenue Cycle not affected) and Hospitals may share risk with Physicians and Post-Acute Care (PAC) Providers. CJR effectively moves all reimbursements to a bundled payment model for 25% of Total Joint Replacements beginning January 1, 2016.
Why Should You Pay Attention?
- Significant financial consequences
- Mandates minimum acceptable performance on three pre-determined quality measures
- Opportunity for Orthopedic alignment
- Major impact to PAC Providers
- CJR will likely expand to many more DRGs
- Claims data is very complex
- More than 70% of Hospital organizations report no experience with episodic payments (as proposed)
- Significant variation in each MSA will affect network implementation
How Are You Responding?
- How will your Hospital and Physician Groups be affected?
- How will you make this mandatory payment model work?
- Are you equipped to effectively manage bundled payments?
- Do you have the robust data and analytics tools, a network of preferred partners established and essential resources identified to effectively manage the risks and opportunities to be successful within this new reimbursement structure?
We Can Help!
ValidCare has the resources and experience to establish both strategy and implementation of a tailored model that will ensure your organization’s success within the CJR Model. Our proven methodologies and Patient Engagement Technologies help ensure you’re Restoring Health…One Patient at a Time.
If you’re interested in learning how ValidCare can help your organization with Bundled Payments, CJR , Reducing Readmissions, or an enabling Patient Reported Outcomes Technology that integrates natively to iOS and Android devices, please contact us.
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