CMS
BLOG
April 1, 2016
By Patrick Conway, CMS Principal
Deputy Administrator and Chief Medical Officer
Our
Hopes for the Comprehensive Care for Joint Replacement Model
Today’s launch of the Comprehensive
Care for Joint Replacement Model (CJR) is a major step toward transforming care
delivery in Medicare. Why? Because this model looks to improve care and quality
for the most common procedures that Medicare beneficiaries have, hip and knee
replacements. In 2014, more than 400,000 Medicare beneficiaries received a hip
or knee replacement, costing more than $7 billion for the hospitalizations
alone. Despite the high volume of these surgeries, quality and costs of care
for these hip and knee replacement surgeries still vary greatly among
providers. For instance, the rate of complications, like infections or implant
failures, after surgery can be more than three times higher for procedures
performed at some hospitals than at others.
The model aligns with what matters
to beneficiaries—better outcomes for a whole episode of care. The model
includes patient-reported outcomes after surgery and incentivizes better care
coordination. One beneficiary said it best when she described that what she
cared about for her hip replacement was getting out of the hospital as quickly
as possible without an infection or complication and then being able to go back
to playing with her grandkids and gardening. The model incentivizes a system
that aligns with her goals and the goals of so many beneficiaries.
We are excited about the CJR
model’s potential to improve the quality and efficiency of care for Medicare
beneficiaries, to contribute toward a health care system that delivers better
care, spends our dollars more wisely, and leads to healthier Americans.
How will CJR work? About 800
hospitals located in 67 selected markets will be accountable for the costs and
quality of related care from the time of the hip or knee replacement surgery
through a post-hospitalization period. They will receive target prices for
these joint replacement cases at the beginning of each year. The target price
represents expected spending for lower joint replacement episodes, including
the initial hospital stay for the procedure and 90 days after discharge from
the hospital. If patients receive high quality care and spending is less
than the target, a hospital may receive an additional payment from Medicare. If
their spending is above the target, hospitals may be required to repay Medicare
for a portion of the difference.
We expect this incentive to
coordinate the services a patient receives before, during, and after surgery
will encourage hospitals and clinicians to partner with nursing facilities,
home health agencies and other providers of rehabilitation services to provide
seamless, high quality care.
We want hospitals to be successful
under this model because success means that Medicare’s beneficiaries will
receive better quality care. In the run up to today’s launch, our staff
individually contacted the program coordinators at all 800 hospitals to offer
data and other resources to assist them on this multi-year journey. CMS will
continue to collaborate with hospitals and their physicians and other
clinicians to provide support and share best practices.
What will beneficiaries notice?
First, beneficiaries will continue to choose their doctor, the hospital where
they receive treatment, and the type and location of rehabilitation care they
receive. If their hospital is a model participant, they will get a letter
explaining the model. Patients whose chosen hospital participates in the model
should experience improved care coordination. For instance, we expect that
nursing facilities will understand a patient’s needs better before that patient
is discharged from the hospital.
The CJR model offers a chance for
hospitals, doctors, and other providers to partner with CMS in furthering our
shared goal of improving the quality of care for beneficiaries undergoing the
most common inpatient surgery, lower extremity joint replacements. The model is
part of the Administration’s broader strategy to improve the health care system
by paying providers for what works, unlocking health care data, and finding new
ways to coordinate and integrate care to improve quality.
We are excited to begin this
groundbreaking initiative and will work with hospitals, physicians, and other
providers throughout the model to ensure they have the tools to succeed and
improve upon what they do best: provide high quality, coordinated care to
beneficiaries.
For more information about the CJR
model, please visit: https://innovation.cms.gov/initiatives/cjr.
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