Many of us in the bundled payment world had barely overcome our surprise at the presidential election results when we heard of the selection of Dr. Tom Price as HHS Secretary. As a component of the much-larger Affordable Care Act, we had hoped that the bundled payment programs would be “under the radar” and might not receive significant attention, at least until later in the administration. But Dr.
CMS has made the option available to BPCI participants to have their targets for the Major Joint Replacement of the Lower Extremity episodes stratified by whether the patient had a hip fracture. This issue is of concern to some BPCI participants because episodes involving fractures are considerably more costly than non-fracture episodes. While non-fracture episodes may cost $20-22,000, fracture episodes are typically 45-50% higher at $35-40,000.
HFMA recently published a short article about the data for the Comprehensive Care for Joint Replacement program that was released in August. However, we have some additional caveats that should be considered in using this data.
In July 2016 CMS released a Notice of Proposed Rulemaking (NPRM) of its intent to implement a mandatory bundled payment program for specified cardiology and cardiac surgery services, along with several other programs. These Episode Payment Models (EPMs) will begin in July 2017 for almost all hospitals located in 98 selected metropolitan statistical areas (MSAs).
An overview of the major metrics involved in assessing risk and opportunity in the major joint replacement episodes involved in the Comprehensive Care for Joint Replacement and Bundled Payment for Care Improvement programs, from the point of view of the analytical team, physician leaders, and finance and operations management.
BPCI participants who started in April 2015 are now eagerly awaiting their first reconciliation, which is scheduled to be released by January 1. Here's an overview of what you'll get with that first reconciliation.
by Gloria Kupferman, Vice President, DataGen Group
In November 2015, the Centers for Medicare and Medicaid Services (CMS) issued its Comprehensive Care for Joint Replacement (CJR) payment model, a pilot bundled payment program for the most common inpatient surgeries for Medicare beneficiaries—hip and knee replacements, known as lower extremity joint replacements (LEJRs). CJR will be mandatory for hospitals in 67 Metropolitan Statistical Areas (MSAs). The CJR model will be mandatory for about 800 hospitals.
On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) released its final rule for the Medicare Comprehensive Care for Joint Replacement (CJR) model. The program will be effective for discharges occurring on or after April 1, 2016, in the 67 designated Metropolitan Statistical Areas (MSAs), unless otherwise noted.