As we finish out this series on CJR, it is important to recall that with the launch of the Comprehensive Care for Joint Replacement (CJR) reimbursement model, Centers for Medicare & Medicaid Services (CMS) refocuses patient care for lower extremity joint replacements (LEJR). Through bundled payments that align the incentives of providers along the entirety of the care continuum, health systems are becoming increasingly accountable for the cost and quality of an episode of care. Yet even in these uncharted waters, health systems can continue to sail smoothly to maximum financial health. Specifically, there are a few tips that we recommend your health system employ along this voyage.
For example, to maintain the focus on the highest quality of care, your health system will benefit from focusing on elements that align with the parameters of the CJR model. These elements include reducing readmissions, standardizing high quality of care through integration, and focusing on patient experience.
In reducing readmissions, your health system will benefit from working closely with all post-acute care (PAC) providers in the patients’ care continuum. By forging an effective relationship that aligns incentives, your health system will financially benefit from the target pricing in the CJR model, specifically as unplanned readmissions have been identified as a key measure of outcome quality in the CJR model.
In standardizing high quality of care through integration, your health system will benefit when LEJR patients choose to stay within your network. Integration and CMS “gainsharing” agreements keep revenues within the system, and with the system’s preferred providers, and allows for reduced readmissions and length-of-stay(LOS), maximizing cost efficiency for your patients. In focusing on patient experience, your patients’ satisfaction will be directly linked to improved LEJR outcomes through the use of the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Now more than ever, patients will expect a more patient-centered approach to care and coordination across different care settings.
Furthermore, your health system will be able to stay the course while navigating the CJR model by ensuring that patients have full choice in PAC provider options. At the end of the day it is the patients’ choice as to where they will transition to and it is important for your patients to choose the right PAC provider. Also, there is variability in care and those outside of your network may not necessarily meet your high standards. To ensure that patients understand the importance of selecting the proper PAC provider, it is important that they be educated on the advantages that your integrated network offers. In doing so, your health system needs a proper tool that is flexible enough to guide patients during this critical bedside decision-making moment.
However, to continue to provide the highest quality of care while maximizing financial health, your health system will not have to sail these changing winds alone. With the right tool, your health system can navigate the CJR waters confidently. A transparent tool that aligns the financial incentives of PAC providers with those of your health system will ensure coordination in the quality of patient care across the care continuum. By utilizing CMS data to allow patients to make an informed care transition, the right tool will increase revenues through integration, or agreements with providers outside of your network, as well as decrease costs through reduced readmissions and LOS. In this sense, while navigating the uncharted waters of the CJR model will not be simple, be confident that your health system can continue to provider the highest quality of LEJR care while sailing home to maximum financial health.
About Janus Choice
Janus Choice can help your health system navigate through this journey by providing you with the digital tool you need to succeed. Janus Choice facilitates informed healthcare transitions between different care settings. With a proven history, we offer an interactive, mobile, and easy-to-use platform for matching patients with the best post-acute care providers. Janus Choice increases top-line revenue for health systems and increases integration of patients that require post-acute care. Request a demo today at [email protected].
1. CMS. Comprehensive Care for Joint Replacement (CJR) Model. https://innovation.cms.gov/Files/fact-sheet/cjr-fs-finalrule.pdf. November 2015.
2. Federal Register. https://www.federalregister.gov/articles/2015/11/24/2015-29438/medicare-program-comprehensive-care-for-joint-replacement-payment-model-for-acute-care-hospitals. November 2015.
3. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services
https://www.federalregister.gov/articles/2015/11/24/2015-29438/medicare-program-comprehensive-care-for-joint-replacement-payment-model-for-acute-care-hospitals. November 2015.
4. CMS. Comprehensive Care for Joint Replacement (CJR) Model. https://innovation.cms.gov/Files/fact-sheet/cjr-fs-finalrule.pdf. November 2015.