FACT SHEET
FOR IMMEDIATE RELEASE
July 9,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
Comprehensive Care for Joint
Replacement
Consumer Fact Sheet
Hip and knee replacements are the
most common inpatient surgery for Medicare beneficiaries and can require
lengthy recovery and rehabilitation periods. In 2013, there were more than
400,000 inpatient primary procedures costing more than $7 billion for hospitalization
alone.
While some incentives exist for
hospitals to avoid post-surgery complications that can result in pain,
readmissions to the hospital, or protracted rehabilitative care, the quality
and cost of care for these hip and knee replacement surgeries still varies
greatly. For instance, the rate of complications like infections or implant
failures after surgery can be more than three times higher at some facilities
than others, which can lead to hospital readmissions and prolonged recoveries. And
the average Medicare expenditure for surgery, hospitalization, and recovery
ranges from $16,500 to $33,000 across geographic areas.
This variation is due partly to the
way Medicare beneficiaries receive care. Incentives to coordinate the whole
episode of care – from surgery to recovery – are not strong enough, and a
patient’s health may suffer as a result. When approaching care without seeing
the big picture, there is a risk of missing crucial information or not
coordinating across different care settings. This approach leads to more
post-surgery complications, high readmission rates, and inconsistent costs.
These are not the health outcomes patients want.
The new proposed
Comprehensive Care for Joint Replacement model is meant to address this
fragmentation by focusing on coordinated, patient-centered care. This model
aims to improve the care experience for the many and growing numbers of
Medicare beneficiaries who receive joint replacements and places the patient’s
successful surgery and recovery as the top priority of the health care system.
- Patients would benefit from their hospitals and other
health care providers (e.g., physicians, home health agencies, and nursing
facilities) working together more closely to coordinate their care.
This could lead to better outcomes, a better experience, and fewer
complications such as preventable readmissions, infections, or prolonged
rehabilitation and recovery.
- In this model, hospitals would be paid for the outcomes
that patients want. Providers would be held accountable for the quality
and cost of services they provide and would be incentivized to help
patients get and stay well.
- Patients would continue to choose their doctor,
hospital, nursing facility, home health agency, and other provider, but
their providers would better coordinate their care. From surgery to
recovery, patients would receive more comprehensive, coordinated care from
their providers regarding the most appropriate options for their recovery
and rehabilitative care.
Here’s how it would work:
- This initiative builds on successful demonstration
programs already underway in Medicare, and among leading employers and
health care providers.
- Under this proposed model, the hospital in which the
hip or knee replacement takes place would be accountable for the costs and
quality of care from the time of the surgery through 90 days after—what’s
called an “episode” of care.
- Depending on the hospital’s quality and cost
performance during the episode, the hospital would either earn a financial
reward or be required to repay Medicare for a portion of the costs. This
payment would give hospitals an incentive to work with physicians, home
health agencies, and nursing facilities to make sure beneficiaries receive
the coordinated care they need with the goal of reducing avoidable
hospitalizations and complications. Hospitals would have additional tools
– such as spending and utilization data and sharing of best practices - to
improve the effectiveness of care coordination.
- By “bundling” these payments, hospitals and physicians
have an incentive to work together to deliver more effective and efficient
care.
- This model would be in 75 geographic areas throughout
the country and most hospitals in those regions would be required
participate.
And why we’re proposing it:
- Joint replacements are the most commonly performed
Medicare inpatient surgery and their utilization is predicted to continue
to grow. They can require long recoveries that may include extensive
rehabilitation or other post-acute care, which provides many opportunities
to reward providers that improve patient outcomes.
- By including all eligible hospitals in 75 geographic
areas across the country, this model would drive significant movement
towards new payment and care delivery models for an important set of
conditions and surgeries for Medicare beneficiaries.
- This project supports HHS efforts to transform
the health care system towards better quality care, smarter spending, and
healthier people by focusing on care transformation and payment reform for
a major surgery for many patients.
The proposal is available at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf
and can be viewed at http://federalregister.gov/a/2015-17190
starting July 14, 2015.
The deadline to submit comments is
September 8, 2015.
For more information, visit: http://innovation.cms.gov/initiatives/ccjr/
HHS Release: http://www.hhs.gov/news/press/2015pres/2015.html
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