5 Things Your Hospital Needs to Know

About Value-Based Care and the CJR Model

This past April, Center for Medicare and Medicaid Services (CMS) implemented the new bundled payment model for hip and knee replacements called comprehensive care for joint replacement (CJR). This is a move towards value-based care in an effort to improve patient outcome and save cost. CMS is rolling out this new initiative for the most common orthopedic procedure, hip and knee replacements. They are starting with 67 geographic areas and roughly 800 hospitals strategically placed in metropolitan areas throughout the country. Some of the hospitals are high volume and in large cities while others are lower volume in smaller cities.

1. All Episode of Care Providers Have Skin in the Game

Traditionally, CMS fee-for-service models didn’t hold the acute hospital where surgery took place accountable after discharge. The new value-based care system or CJR model would hold all care providers accountable for a 90 day episode of care from surgery through recovery. Therefore, all parties will want to be conscientious of who they partner with whether it’s a hospital, physical therapist, or outpatient clinic. If a patient suffers complications and is readmitted to the hospital, the data will be reported back and if costs get too high all parties will be penalized.

2. Using CMS Data as a Baseline for Making Decisions

If your region has been selected to be apart of the new CJR model you should have received your CMS historical data on how much an episode of care costs on average. In a recent article in Becker’s Hospital Review, the Vice President of Business Development of Signature Medical Group, Jim Gera, was quoted as saying, “If you haven’t gotten your CMS data, you need it. Don’t rely on the CMS summary data. It might not be accurate enough. You need to crunch the numbers yourself,” said Mr. Gera. “You need to know where you are at now and where you are going. It’s not going to be the same for everyone.”

Having a baseline will help your organization determine where you need to focus to improve. CMS should provide your region’s target price so your facility will know what you’re aiming for when it comes to cost of episode of care.

3. Adding Resources to the Overall Care Team Picture

Some hospitals are electing to add new resources to oversee the overall picture of episode of care. In some cases this may be adding case managers or social workers to the care provider team.

4. Don’t Overlook Patient Recovery Costs

Prior to the CJR model, hospitals were not held accountable for the recovery period, however, in the new CJR model they are.

For example, if a patient acquires DVT within 30 days postoperatively the hospital is responsible for treatment costs. CMS estimates that the average cost to treat DVT is $50,937 per episode (source: CMS Quality Chart Handbook). This illustrates Medicare’s motive for value-based care.

5. Reducing DVT and Improving Overall Value Based Care

Compression Solutions makes a portable sequential compression device called Triple Play VT that can be used in the hospital and at home during the recovery process. For a hospital that performs 300 knee and hip replacements a year the average DVT occurrence with anticoagulants alone is 2%-15%. However, in that same scenario when adding a mechanical prophylaxis such as Triple Play can reduce the number of DVT occurrence to 1% – 3.7%. In that example, the savings the hospital could potentially save is approximately $152, 811 – $1,731,858.

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These are just a few ways to help your hospital to stay on top of the new CJR model before the first assessment, which is just right around the corner. It’s also important to note that many private health insurance companies have also adopted this bundled payment model. Most healthcare industry experts are claiming that the bundled payment model is the future of healthcare and it is essential for hospitals to not ignore this first year while CJR gets off the ground.

If you’re interested in saving money and improving patient recovery by using our low cost sequential compression device, we’d love to tell you more about how we can make our product work for your hospital and patients.