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Taking Stock After the First 100 Days of CJR
August 01, 2016

Taking Stock After the First 100 Days of CJR

Launched on April 1, 2016, the Comprehensive Care for Joint Replacement (CJR) model is the first mandatory bundled payment program from CMS. To ensure that they are getting the most from the initial CJR data feeds from CMS, hospitals must understand what can and cannot be measured, and take steps now to address any issues.
What the Second 2016 Data Feed Can Reveal: Exercise Caution When Comparing Financial Performance of Complete Claims

The second performance data feed is expected in October 2016. This will include a complete refresh of all claims submitted, including those for episodes included in the first data feed. By October, all episodes that began in the April to June performance period will have ended and many will be “complete” in terms of claims included in the data feed. That is, they will have been paid and in the data feed. 
 
However, hospitals must exercise caution when determining which episodes from the April to June performance period can be compared to the target. While participating providers should have claims for the first postdischarge setting—such as SNF, inpatient rehabilitation, and home health—they should evaluate the financial performance only for those episodes that ended at least 2 months before the data were cut.  Even when the initiating hospital has submitted and received payment for the episode of care, other providers may not have submitted and/or received payment for their services.
 
Hospitals can also conduct the first evaluation of their readmission rates to assess how often infections are occurring, whether chronic conditions are properly managed, and how many revisions are necessary.
 
Remember that hospitals may be financially accountable under the program rules even if they believe a readmission is not related to the patient’s joint replacement. For example, if the patient is readmitted for congestive heart failure during the third month, that readmission will count as part of the episode of care.
 
The postacute network and discharge pattern is an important metric that can be examined in part from the initial performance data feed, and more fully in the second performance data feed. It is critical to know which postacute providers are receiving the hospital’s CJR patients; if the hospital has established a preferred network, the October data feed can help it determine if those providers are being used. Participants will have enough data at this point to assess the readmission rate from those postacute providers, as well as to determine whether length of stay (LOS) protocols for SNFs are being followed. 
 
Importance of Postacute Care Coordination Under CJR: Appropriate Home Care Could Yield Significant Savings

Clearly, coordination with postacute providers is critically important in managing care and costs under CJR. Nationally, most spending following acute care for joint replacements has occurred within 5 to 10 days of discharge, and, not surprisingly, SNFs are responsible for the greatest portion of that spend. Ensuring that all appropriate patients are referred to home care rather than SNFs can yield significant savings, and coordinating protocols and the care transition with SNFs that admit the facility’s CJR patients is also essential.
 
If a participant does not have a SNF network in place, it should develop one now. At a minimum, it should require participating SNFs to provide key metrics, such as hospital readmission rates, percent of discharges to home health, LOS, patient satisfaction, and Medicare star rating. Most importantly, hospitals should begin preparing for discharge and postacute care as soon as the joint replacement procedure is scheduled, and consider implementing a strong “prehab” program if one is not already in place. 

 
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