Bundled payment episodes for major joint replacement (MJR) have been among the most successful "experiments" into the BPCI and CJR programs. Most BPCI participants in MJR episodes have been effective in reducing post-acute institutional utilization, and have achieved significant cost savings in these episodes. Among our clients participating in the CJR program, about 35% achieved savings that exceeded the stop gain limits; another 25% achieved savings that did not exceed the stop gain limits, and only 25% had losses.
CMS Comprehensive Care for Joint Replacement Program
by Jonathan W. Pearce, CPA, FHFMA, Principal, Singletrack Analytics, LLC and Steven Wood, PhD, VP of Research and Strategic Partnerships, CODE Technology
By Jonathan Pearce and John Kalamaras
CMS has recently proposed to remove total knee arthroplasty (TKA) surgical procedures from the Medicare "inpatient-only" list, which would allow those procedures to be performed on an outpatient basis.
In our previous article on this topic we suggested that participants in the CJR program shouldn’t expect the amounts in their initial Performance Year 1 (PY1) reconciliation to be final, and should instead expect their NPRAs to decrease in the final reconciliation that will occur in 2018. This is because claims will continue to be processed until the final reconciliation, so episode costs will increase while targets will remain constant.
This interview with Jonathan Pearce occurred at the Interdisciplinary Summit on Orthopedic Value-Based Care in Newport Beach CA on January 21 2017. At that conference Jon presented on "Using Data to Develop CJR Strategies - 5 Things to Know" and "How Analytics Can Support Physicians"
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
About 800 hospitals are staring down the barrel of the Medicare Comprehensive Care for Joint Replacement (CJR) payment program, which will be implemented on April 1. Those hospitals that have gone through the somewhat-arduous process of signing up to receive their claims data and downloading it from the CMS portal now have the opportunity to use that data to begin to understand their CJR episodes of care and to design a strategy for success under the program. The steps below outline the beginning of a data-driven strategy for CJR.