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The reality of CCJR: Understanding new risks facing hospitals

The projected debut of the Comprehensive Care for Joint Replacement (CCJR) Model is less than three months away, and it represents an entirely new approach for care and cost management. Affected hospitals are beginning to realize that the financial, operational and clinical risk they are responsible for managing is a much larger task than they had originally envisaged. When the Centers for Medicaid & Medicare Services (CMS) first proposed the program, CMS wanted to demonstrate a new way to achieve better care, smarter spending, together with healthier people and communities through coordination of care across inpatient and outpatient healthcare providers. Hospitals are realizing their internal resources are not well-aligned with the requirements for analyzing and administering a CCJR program. What is the risk hospitals must manage? A large proportion of services included in a CCJR episode are non-hospital based. In […]

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What is the Comprehensive Care for Joint Replacement (CCJR) program?

  • Jeff Goldstein, MD, MS FACHE
  • 09/29/2015

In July 2015 the Centers for Medicare & Medicaid Services (CMS) announced the proposed CCJR program, a five-year initiative for addressing bundled inpatient and outpatient payments for patients who have lower-extremity joint replacement surgeries. Perhaps the most important aspect is the endpoint for the episode of care, which is 90 days after discharge. During this period CMS will pay all providers, inpatient and outpatient, using the current fee-for-service model. However, the proposed rules would hold the hospital accountable for the cost of services (both inpatient and outpatient) relating to the patient’s procedure and post-surgical care. This new risk/reward arrangement presents significant financial implications for the hospital. If a hospital can control costs and demonstrate quality during both the hospitalization and post discharge, then it can receive a bonus payment. Conversely, if the aggregate cost of care during the 90-day window […]