Single Tracks Blog Archive

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.

National Bundled Payment Summit 2015 Presentation - Video

At the National Bundled Payment Summit in Washington DC last June, we presented a session on risk and opportunity in bundled payments. Jon Pearce from Singletrack Analytics gave an overview of risk and opportunity in bundled payments, while Jessica Walradt from the Association of American Medical Colleges and Lily Pazand from NYU Langone Medical Center discussed successes and challenges in their related organizations.

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.

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