Fact Based List:
16 Things to Know About the New CMMI Comprehensive Care for Joint Replacement Model
Submitted by Clive Riddle on Mon, 07/20/2015 - 11:59
- The model involves Hip and knee replacements: lower extremity joint replacements or LEJR
- In 2013, there were more than 400,000 LEJR inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone
- The average Medicare expenditure for LEJR surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas
- The model tests bundled payment and quality measurement for an episode of care to encourage providers to work together from initial hospitalization through recovery
- A LEJR episode is defined as admission of eligible Medicare FFS beneficiary to a hospital paid under IPPS that results in discharge paid under MS-DRG 469 or 470
- The LEJR episode would continue for 90 days following discharge
- Part A and Part B services related to the LEJR episode would be included in the episode
- Annually for 5 years, the model sets Medicare LEJR episode prices for each participant hospital that includes payment for all related services received by eligible Medicare FFS beneficiary
- All providers and suppliers would be paid under the usual payment system rules and procedures of the Medicare program for episode services throughout the year
- Following the end of a model performance year, actual spending for the episode would be compared to the Medicare episode price for the responsible hospital
- Depending each hospital’s performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for portion of the episode
- The CCJR model is proposed for 75 geographic areas, defined by metropolitan statistical areas (MSAs)
- Hospitals outside these geographic areas would not be able to participate in the model
- Beneficiaries in the 75 MSAs would retain their freedom of choice to choose services and providers
- There is no application process for this model
- Except for hospitals participating applicable models of the BPCI initiative, hospitals paid under the IPPS and located in selected MSAs be required to participate in the CCJR model
Source: CMMI: Comprehensive Care for Joint Replacement Model
Source URL: http://innovation.cms.gov/initiatives/ccjr/
List Ratings: |
Lists You Might Also Be Interested In
- Home-Based Palliative Care in an MSSP ACO: 3 Takeaways
- Top 10 Top-Grossing Public Hospitals
- Health Affairs Blog: 4 Major Barriers to Delivering Patient-centered Care
- UBA: U.S. Regions With Highest % of CDHP Plans offered by Employers
- HFMA: 7 Considerations in the Financial Modeling of Value-Based Payment Arrangements
Login or register to post comments