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The Comprehensive Care for Joint Replacement (CCJR), has organizations’ leadership wondering how they will be able to perform in such a model. Here are some tips.
It should be obvious to everyone by now that value-based care is gaining acceptance and is here to stay. The latest proposed model from The Centers for Medicare and Medicaid Services (CMS), Comprehensive Care for Joint Replacement (CCJR), is CMS’ first mandatory bundled payment program and surely has organizations’ leadership wondering how they will be able to perform in such a model.
KoertnerCCJR, if implemented, will begin January 1, 2016, and it will impact hospitals in 75 Metropolitan Statistical Areas (MSA) that aren’t currently participating in BPCI (Bundled Payments for Care Improvement). The five-year program includes just two MS-DRGs (469 & 470) and phases in stop-loss for the 90-day bundles with no risk in the first year.
These programs make sense. CMS expects to save more than $150 million over the lifetime of the bundled payment model. What may not be clear is how organizations will implement the efficiencies necessary to not only survive these changes in healthcare reimbursement but to also maximize potential reconciliation payments so they earn their share of the savings.
Success will boil down to three areas of focus: preparation, partnerships, and technology.
Undoubtedly, as analysis is done on current post-acute spending, you’ll find some partners out-performing others. Organizations are going to have to align themselves with partners who deliver on high standards of care, are able to provide necessary metrics on quality, cost, and patient satisfaction, and are able to communicate effectively to prevent complications or react quickly when they arise.
Demand will be high for these partnerships, so even if you aren’t directly affected by CCJR, you should be securing these relationships now. While hospitals participating in CCJR must retain 50% of downside risk, gainsharing could be considered as a tool to ensure compliance.
Enough emphasis cannot be placed on the role technology has in successful CCJR participation (or any other bundled payment program for that matter). Many organizations are simply using excel spreadsheets to track patients in bundled payment programs.
While that may work for a very small population, it isn’t realistic to think they can manage innumerable patients the same way. Also, while electronic health records (EHRs) track and identify trends in patient lab values, notes, histories, and medications-for the most part they are not able to formulate or customize a plan of care or identify patients at risk of falling off that plan.
Specialized software solutions will be necessary to effectively track patients through the continuum of care. Look for solutions that:
Additional technology to consider are:
CMS has pledged to shift 50% of Medicare payments to alternate forms by 2018. Organizations must get ready.
Karla Koertner is a certified project management professional and lead consultant at Galen Healthcare Solutions with 14 years of healthcare software experience.