Bundled Payment Pilot

Dissecting DRGs for Bundled Payment

Choosing Fracture-Based Targets in BPCI

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.

Limitations on Usefulness of Recent CJR Data

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.

Risks and Opportunities in Medicare’s Cardiac Bundled Payment Program

Jonathan W. Pearce, CPA, FHFMA


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).

Major Joint Replacement By the Numbers - Bundled Payment Summit Presentation

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.

Presented at the National Bundled Payment Summit, Washington DC, June 8 2016


Making Sense of Your First BPCI Reconciliation

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.

Unravelling the Mysteries of BPCI Reconciliation

By Jonathan W. Pearce, CPA, MBA, FHFMA and Jessica Walradt, MS

The Top Ten Things You Need to Know Now That the Medicare CJR Program is Final

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.

Medicare Comprehensive Care for Joint Replacement - Final Rule Summary

by Gloria Kupferman, Vice President DataGen Group

Overview and Resources

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.

How Your New Contract Physician Group Killed Your Bundled Payment Program

After several months of negotiations you've reached agreement with a contract physician group to provide hospitalist services in your hospital. This group has particular expertise in helping patients with multiple comorbidities and focuses on making sure that those patients get into the proper post-acute setting, which you hope will improve your performance in the Medicare Bundled Payment for Care Improvement (BPCI) CHF and COPD episodes in which you’re participating.

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