CMS releases first CJR bundled payment results: What to know
CMS just released the first Comprehensive Care for Joint Replacement (CJR) data feed. Find out what the preliminary results show.
CMS’ first mandatory bundled payment model, the
PriceRecently, CMS released the first data feed from the program. The information, which includes data on relevant episodes of care that began from April 1 to early June, is critical to the more than 750 hospitals participating in the program.
To gain more insight into the data and what it means for readers, Managed Healthcare Executive spoke with Kelly Price, vice president and chief of healthcare data analytics at DataGen, a subsidiary of the Healthcare Association of New York State.
Quick program overview
The CJR program includes episodes triggered by hospitalizations of eligible Medicare fee-for-service beneficiaries discharged in the following diagnosis related groups (DRGs):
- MS-DRG 469: Major joint replacement or reattachment of lower extremity with major complications or comorbidities.
- MS-DRG 470: Major joint replacement or reattachment of lower extremity without major complications or comorbidities.
The episodes include the hospitalization and 90 days post-discharge, and all Part A and Part B services associated with the care (with a few exceptions).
After each performance year, actual episode spending will be compared with episode target prices set by CMS. If actual spending is lower than target prices and the hospital meets quality metrics, the hospital can share in the savings; if actual spending is more than the CMS targets, hospitals share in the losses.
Hospitals will experience no risk in performance year 1 (which began April 1), meaning they will not need to repay Medicare if they do not meet quality and cost targets.
What the initial data included
The data released by CMS included some surprises, such as a “rerelease” of the CJR baseline data and targets for hospitals, says Price, noting that the change was made to correct an error in the original release.
“It was a very small change and it only served to increase some of the targets by about a half a percentage point,” Price says. “I think what is important to understand there is that with all of these new programs, CMS is continuing to refine their methodology. It’s extremely complicated and so there are errors periodically.”
CMS also changed the format in which it released the data, in an effort to provide additional information to hospitals and make it easier for them to use the data, says Price.
These format changes included files that contained aggregate data that hospitals can use to determine how many episodes were included in each month, and files on claim level data “where you can see the truth in detail,” she says.
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