On Nov. 16, 2015, the Centers for Medicare and Medicaid released the final rule for its Comprehensive Care for Joint Replacement (CJR) model.

The rule intends to streamline hip and knee replacements and other major limb surgeries for Medicare recipients by bundling payment plans for hospitals and other treatment facilities. Rather than simply being responsible for the procedure itself, the reimbursements of facilities in 67 geographic areas are now tied to the entire episode of care, starting with the surgery and extending to 90 days after discharge.


What hospitals need to know

The ultimate goal of the CJR model is to improve patient outcomes and lower costs by decreasing variation across joint replacement procedures, and bundled payments are the means by which the CMS is attempting to accomplish this effort. For hospitals, these new payment plans are changing the way that facilities are reimbursed for care. Rather than simply being responsible for the procedure that is performed within its walls, payment is tied to the entire episode of care.

Consequently, to maximize reimbursements hospitals and other healthcare facilities need to be intentional about coordinating care from beginning to end. That may mean employing a patient navigator or other health care professional to streamline the process from admission through discharge and rehabilitation. To maximize reimbursement, it is also critical for facilities to standardize procedures based on best practices. This will decrease costs, improve outcomes and lower the likelihood of readmittance, providing value-based care for patients. Pursuing physician alignment will help hospitals to achieve both of these goals by ensuring that providers are delivering the same care before, during and after procedures, and are familiar with the coordination efforts with outside facilities organized by the hospital.

Manage your program with Wellbe

Wellbe’s solution helps ensure that your patients get the best possible care and your program remains profitable by leveraging digital patient navigation to make the most of existing resources.

Maximize your organization’s CJR gainsharing dollars:

  • Eliminate variation across episodes
  • Coordinate care with connected teams
  • Increase patient engagement
  • Collect patient-reported outcomes for 2 quality points
  • Increase satisfaction for HCAHPS points
  • Mitigate post-acute care costs

The program helps us engage with patients in a new, innovative way, empowering them to be educated and involved in their care. From pre-operative preparation to post-operative rehabilitation, the program will provide patients with the information they need to achieve the best possible outcome.

Director of Orthopedics & Rehabilitation, Meriter-UnityPoint Health


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