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    Three ways hospitals can prepare for CMS’ CCJR model

    April 1 marked the start of the CMS Comprehensive Care for Joint Replacement (CCJR) model, which the government agency hopes will support better and more efficient care for its beneficiaries undergoing hip and knee replacement surgeries, the most common surgeries among Medicare patients.

    McNerneyMcNerneyAccording to CMS, the rate of complications such as infections or implant failures can be more than three times as high at some facilities than at others—and that leads to hospital readmissions.

    In 2014, there were more than 400,000 hip and knee replacement procedures, which cost $7 billion in hospitalizations alone. The cost to the government agency was an average of $16,500 to $33,000 for surgery, hospitalization, and recovery across geographic areas in this time period.

    With the CCJR model, participating hospitals are held financially responsible for the quality and cost of the surgical procedure, which starts when the patient is admitted and ends 90 days after their discharge from the hospital.

    Prep tip 1: Focus on post-acute recovery decision-making

    The biggest opportunity for hospitals and health systems involved in the CCJR model is in the post-acute recovery space, says Andrew McNerney, consulting manager with GE Healthcare Camden Group.

    In situations where providers have a financial stake in a home health provider, they may be able to play a direct role in changing the cost and quality of care, he says. While many providers will choose a select few home health providers based on care quality, still another option is keeping a patient an extra day in the hospital—that is, if the provider is unsure of the quality of care delivered at a particular post-acute care facility.

    “It could just come down to providers doing the math and figuring out what the last day in the hospital really costs—it certainly doesn’t cost as much as the first day, but it’s the math that providers are interested in doing. If they hold on to the patient, they will have control over the cost and quality of their care,” he says.

    Next: Prep tip 2


    Aine Cryts
    Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, ...


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