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Traditional Values. Innovative Care.

Bundled Payments

Posted: 8/12/16
Tracy Milius, OT

The Comprehensive Care for Joint Replacement Model (CJR) is a new bundled payment model being tested for episodes of care related to total knee and total hip replacements under Medicare. The model is being tested in 67 metropolitan statistical areas for 5 years and began April 1, 2016. Programs under the model will be administered by hospitals in the participating areas, and therapy practices will be impacted in those areas.

RehabVisions provides patient outcomes in a cost-effective way for our hospital partners. We are focused on providing the best clinical practices so that referrers will continue to choose our services.

Important to Know:

  • Purpose. The Purpose of CJR is to promote quality and financial accountability for episodes of care for lower extremity joint replacement (LEJR), and to test whether bundled payments to certain acute care hospital for LEJR episodes of care will reduce Medicare costs while improving quality.
  • Hospitals. The hospitals where the surgery occurred is the only risk-bearing entity under this model and will be responsible for the Medicare cost of care for services provided during the entire 90-day episode. If the total spending is less than the Medicare target, the hospitals may be eligible to receive additional payment from Medicare—but if they spend more than the Medicare target, they could be required to pay back Medicare for some portion of the difference.
  • Reimbursements. Reimbursements will remain under normal payment methods for outpatient therapy services, Medicare physician fee schedules, SNF Part A, SNF PPS for Part A, and starting year two, CMS will waive the three day hospital stay required for SNF payment (if the SNF has an overall quality rating of three stars or better).

As we move forward in the CJR model, leveraging episode data to align care providers, clinical protocols and care pathways with the patient as the core focus is essential for success. CJR opens the door for therapists to improve communication with referring physicians and collaborate on patient quality care while remaining aware of total visits and dollars spent.

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