Are patients recovering from a total joint replacement a significant part of your therapy practice? If the answer is yes, then you may see significant changes this calendar year in the type and quantity of rehabilitation services these patients receive.
What is the Comprehensive Care for Joint Replacement program?
Beginning April 1, 2016, the Centers for Medicare and Medicaid Services (CMS) is implementing the Comprehensive Care for Joint Replacement (CJR) program in 67 Metropolitan Statistical Areas (MSAs). The purpose of the program is to promote cost-effective quality care of a patient’s condition over a period of time. This will require a shift from the focus many providers currently have which is focusing on the delivery of cost-effective, quality care in their own particular setting. Most providers have never been faced with having to partner with other providers in managing the care of a patient across the continuum of care.
A Few Facts About CJR Program
Here is what we know:
- The program begins April 1, 2016 and continues through December 31, 2020.
- The program is specific to total hip and total knee joint replacements only, with or without complications (MS-DRG 4690 and MS-DRG 470).
- All Medicare certified hospitals in the 67 MSAs are required to participate. If a patient who elects to have a total hip/knee joint procedure does not want to be part of the program, they have the option of going to a hospital in a non-participating MSA.
- The program is intended to measure both the costs and the quality of care provided to total hip/knee joint replacement patients during their hospital procedure and for all services received during the following 90 calendar days, regardless of where they receive care.
- Participating hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and outpatient rehabilitation facilities will continue to get paid under the fee-for-service program, just as they are today.
- The costs of all services the patient receives will be counted beginning with the surgery and post-op hospitalization, and 90 days post-discharge – no matter how many post-acute care providers they utilize. The “cost” will be measured against a benchmark price that CMS will publish later in the program.
- The first year of the program will be a “trial” period where providers will participate and receive information on their performance.
- Beginning in the 2nd year of the program (e.g. January 1, 2017) providers’ performance will be measured against the “target price” and target quality performance standards set by CMS. Providers whose performance is below target will have to return of a portion of the payment they received. Providers whose performance is above target will receive a bonus payment.
What Does It Mean for Providers?
Since each hospital in the CJR markets will determine how to partner with post-acute care providers in their market, there is likely to be variability across the country in how the CJR is actually implemented. But what can physical and occupational therapists do to prepare? Consider the following aspects of patient care:
- Transitions: Do you provide recommendations on the functional impairments that need to be addressed in the next care setting and what does not?
- Medically necessary care is cost-effective care: Analyze the services you are providing to total hip/knee replacement patients to ensure they are meaningful, proven effective, and require the skills of a therapist.
- Outcomes: Can you say with certainty your care is effective? Do you measure comprehensive patient outcomes with a standardized, objective tool? Are you measuring patient satisfaction?
The CJR program is just the beginning of what providers can expect over the next decade: a shift in focus from “setting-specific” measures and payment to “condition-specific” measures and payment. Therapists in CJR markets can gain experience for this paradigm shift by implementing patient care strategies to provide the right care at the right time.