The Center for Medicare and Medicaid Innovation’s (CMMI) new bundled payment model, Comprehensive Care for Joint Replacement (CJR), will begin on April 1, 2016. The model requires mandatory involvement of hospitals in 67 Metropolitan Statistical Areas (MSAs). Beginning in year two of the model (episodes with an acute care admission on October 1, 2016, or after), these hospitals will be at financial risk for the total cost of all Medicare lower extremity joint replacement (LEJR) surgeries. Hospitals need to manage the entire episode of care for these patients from three days prior to hospital admission through 90 days post-discharge (or 120 days if post-episode spending is considered).
It’s true that CJR is a complicated model and requires major adjustments within most hospital systems. So where should hospitals begin? Here are five ways to prepare for CJR.
1. Assemble a CJR Team
In order to achieve success in bundled payments and CJR, it takes a village. A variety of talents are required to implement a model of this magnitude. Does a participating hospital have people to manage patient cases, implement IT strategies, analyze data, align stakeholders, work with the Centers for Medicare and Medicaid Services (CMS), and drive strategic decisions?
Hospitals need to evaluate their ability to fulfill the roles and responsibilities needed to successfully implement CJR. Which staff members need to be an integral part of planning, implementing, and managing the model? Evaluate current workloads and decide if internal staff duties can be rearranged, or if more staff needs to be hired. If new staff needs to be hired - do not delay. Allow time for proper education on the details and complexities of CJR. Perhaps most importantly, a model such as CJR needs someone at the helm. Who is the CJR leader?