To be successful in this program, you will need to optimize your day-to-day workflow, ensuring that your patients receive better care at a lower cost. We at the Remedy CJR team believe that there are 6 Steps to Success.
The Six Steps
1. Understand how the program works
- Program Methodology
- Pricing, Risk Stratification
Correct CJR Patient Identification
Identify eligible patients to avoid over-management
- Patient Preparation
- Next Site of Care Decisionmaking
Post Acute Coordination
- Incentive Structure
Capture of Quality Measure
Collection and reporting
Data Analytics and Reconciliation Expertise
- CMS claims reporting + Real-Time, actionable data to inform Care Redesign
- Episode-Level auditing of CMS’ reconciliation
Remedy is working with over 900 healthcare facilities to help manage the reimbursement risk and care for over 225,000 Medicare beneficiaries annually. Specifically, 300 facilities elected the bundle for Major Joint Replacement of the Lower Extremity.
The redesign of processes for higher quality, and more efficient service delivery through coordination across continuums of care can result in reduced Medicare expenditures.
An example of our success is illustrated in the chart to the right. This Remedy Partner achieved a 69% reduction in inpatient rehab facility usage and a 13% reduction in skilled nursing facility within its first 3 months in the program, as shown in the graph below.
Results like these are a strong indication that the 6 Steps to CJR Success will lead to a positive outcome for your CJR program.
What is CJR?
CJR is the United States’ first mandatory alternative payment model. The program rules are modeled similarly to a CMS demonstration project, the Bundled Payments for Care Improvement Initiative (BPCI).
Under CJR, hospitals will be incentivized to provide high value care for patients undergoing Major Joint Replacement of Lower Extremity (total hip and knee replacement) in episodes spanning hospital admission until 90 days post-discharge. If hospitals maintain or improve the delivery of high quality, cost-effective inpatient and post acute care, they will be eligible to receive savings generated from those lower-cost episodes.
The program starts on April 1st, 2016, and includes MS-DRGs 469 and 470 for patients that have Medicare A + B as their primary insurance.
All hospitals within 67 Metropolitan Statistical Areas will be held financially responsible for all costs associated with Medicare beneficiaries undergoing hip or knee replacement.
Episodes span from inpatient admission through 90 days post-discharge, and include most costs spanning that period. The program is retrospective: fee-for-service billing does not change.