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Bundled payment starts today

Posted by Dr. Richard Cassidy on Apr 1, 2016 3:55:37 PM
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INTRODUCTION:

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CMS announced that a new mandatory payment model will go into effect beginning TODAY.  Comprehensive Care for Joint Replacement (CJR) will hold hospitals and their partners accountable for quality measurement for an episode of care associated with knee and hip replacements – from initial hospitalization through recovery. This is the latest example of CMS migrating toward a value-based reimbursement model.

Why joint replacement?

CMS is focusing on join replacement because it is a relatively common and expensive procedure that has wide variations in costs that are not correlated to quality or outcomes. In 2014, there were more than 400,000 procedures, costing more than $7 billion for hospitalizations alone. By using a gradual but mandatory approach, systems can analyze data to develop specific plans and processes to gain control of the entire joint replacement process, thus saving millions in healthcare spend.

How does it work? 

CMS has targeted 800 hospitals in 67 geographic regions and will hold them accountable for 90 days including post-acute care. Using a pre-determined target price for an episode of care, CMS will measure spending. If the spending exceeds the target, the facility will have to pay the excess to CMS. On the flip side, if the cost comes in below target, CMS will offer a reimbursement bonus.

How will this help?

By bundling the payments that are received for joint replacement, the CJR model will begin to hold hospitals financially accountable for the quality and cost of care during an episode of treatment. The focus will be specifically on prehospital factors (social, functional status), factors within the hospital (costs of implants, unneeded testing, delayed in definitive care) and post-acute care (inpatient or outpatient rehabilitation, skilled nursing facilities and home health, readmission rates and drivers) as well as physician practices and preference.



This program will encourage a better quality experience for the patient and lower costs for the healthcare system – delivering a win, win situation for all involved. If you are interested in how you can become part of this solution, please contact info@citrahealth.com. We are in the business of making healthcare simple.

 

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Dr. Richard Cassidy

Written by Dr. Richard Cassidy

As senior vice president of clinical performance and analytics for Citra Health Solutions, as well as serving as CEO for ACO Health Partners, a Jacksonville, FL based accountable care organization, Dr. Cassidy leads data-driven interventions within populations in order to achieve the “triple aim”. By bringing an experienced physician’s point-of-view to Citra’s analytics and care management programs, he ensures the effective management of patient populations. Prior to joining Citra, Dr. Cassidy served as vice president, health services at Teladoc, Inc., the leading telehealth provider in the industry. He has also served as chief accountable care officer for Walgreens, managing their MSSP ACOs and population health initiatives and has over 19 years of managed care experience through three different insurers. The most recent position was as chief medical officer at Blue Cross Blue Shield of Tennessee. His expertise is renown in population health management, disease management, provider relationship management and negotiations, as well as care, network and medical informatics strategy development is extensive. Board certified in Internal Medicine, he received his medical degree from Hahnemann University in Philadelphia, Pennsylvania as well as a Master’s degree in Business Administration from Barry University in Miami Shores, Florida. He previously practiced Emergency Medicine in south Florida.

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