Demystifying Medicare’s CJR Mandate for Healthcare Providers

Medicare’s anticipated Comprehensive Care for Joint Replacement (CJR) initiative is underway. The mandate requires that hospitals hold themselves accountable for all outcomes and costs of care provided to fee for service beneficiaries undergoing joint replacement procedures. But that is not to say that healthcare providers, though not directly accountable for the CJR episode costs, will be immune from the impact of the new rule. In fact, the success of these hospitals will be highly dependent upon them and their efforts to deliver successful patient outcomes. As such, hospitals may actively seek to work with joint replacement surgeons and other collaborators in order to improve the care delivered during a patient episode.

"Through this short series of weekly posts, we will demystify Medicare’s joint replacement mandate in an effort to clarify what CJR means for healthcare providers and patients."

 

Through this short series of weekly posts, we will demystify Medicare’s joint replacement mandate in an effort to clarify what CJR means for healthcare providers and patients. CJR affords healthcare providers some opportunities to not only participate in the rewards of a successful CJR initiative, but to also take advantage of the new changes Medicare has implemented.

Below are 3 key opportunities for surgeons and other healthcare providers within a CJR model. We will dive into the following opportunities in the coming weeks.

Gainsharing

  • Financial arrangements
  • Conditions for gainsharing
  • Limits on gainsharing and risk


Increased Flexibility in the Post Acute Setting

As a result of the following medicare CJR waivers:

  • Telehealth billing
  • Post-discharge home visits
  • SNF 3 day qualifying stay
  • Patient engagement incentive

 

Enhanced Patient Satisfaction

  • Care Redesign 
  • Leveraging digital health technology

 

by Ben Torres

Ben Torres