Comprehensive Joint Replacement (CJR)

On November 16 2015 the Centers for Medicare & Medicaid Service (CMS) posted the Final Rule for Comprehensive Joint Replacement (CJR). 

This model aims to support better and more efficient care for patients going through the most common of inpatient surgeries for Medicare beneficiaries, knee and hip joint surgeries. Despite the common nature of these surgeries the costs among providers varies greatly. In 2014, there were more than 400,000 procedures, costing more than $7billion for hospitalizations alone. The new model aims at controlling these costs, delivers better care and leads to healthier Americans. The model start date for this porgram was April,1, 2016.

In the CJR model, beneficiaries retain their freedom of choice to choose services and providers. Physicians and hospitals are expected to continue to meet current standards required by the Medicare program. The CJR model has the potential to improve quality in four ways. First, the model adopts a quality first principle that requires that hospitals meet minimum level of episode quality before receiving reconciliation payments when episode spending is below the target price. Second, higher episode quality may lead a hospital to receive quality incentive payments. Third, the model incentivizes hospital to avoid expensive and harmful events, which increase episode spending and reduce the opportunity for reconciliation payments. Finally, CMS provides additional tools to improve the effectiveness of care coordination by participant hospitals. These tools include information about spending and utilization data, waiving certain Medicare requirements to encourage flexibility in the delivery of care, and facilitating sharing of best practices between participant hospitals.

How can Harmony Healthcare International, Inc. (HHI) help?

Harmony Healthcare International, Inc. (HHI) can assist facilities to prepare for these changes by:

  • Reviewing SNFs overall outcomes and cost of care for these patients, as hospitals may choose to refer to SNFs who do well in both these areas.
  • Preparing SNFs to share program information and financial results with potential hospital partners.
  • Helping to improve overall Five-Star Quality Rating, 
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