The long-awaited Comprehensive Care for Joint Replacement initiative (CJR) became reality on April 1, 2016. Under CJR, hospitals must find ways to rein in costs, reduce complications and improve patient outcomes for hip and knee replacements—the most common joint-replacement procedures—in order to receive maximum reimbursements from the Centers for Medicare & Medicaid Services (CMS).
Improving the patient experience with rehabilitation and recovery after joint surgery counts big in CMS’s new Comprehensive Care for Joint Replacement (CJR) payment model. So it behooves hospitals to manage patient expectations about their discharge destination and rehab care as early in the care episode as possible.
This week, CMS released its final rule for Comprehensive Care for Joint Replacement (CJR), putting 790 hospitals on notice that hip and knee replacement reimbursements from the nation’s largest insurer will be tied to cost containment and high standards for patient care.
Setting expectations early is shown to improve patients' episodes of care, improve patient outcomes and reduce readmission rates. It also prepares your hospital for Centers for Medicare & Medicaid Services (CMS) initiatives like Comprehensive Care for Joint Replacement (CJR).
Preparing for the CMS Comprehensive Care for Joint Replacement Project
Research continues to find that in-home rehab after joint surgery is as cost-effective and equal in outcomes and patient satisfaction to inpatient rehab facilities.
The most important takeaway from the latest CMS effort to rein in costs, achieve positive patient outcomes and lower hospital readmission rates and complication rates is that hospitals must now manage the entire episode of care.
CMS’s Comprehensive Care for Joint Replacement (CJR) bundled-payment program mandates that 790 U.S. hospitals take responsibility for the care quality and total cost of hip and knee replacements, from surgery out through 90 days of rehabilitation and recovery. But the writing is on the wall for all hospitals, health systems and providers: Engaging patients throughout the care continuum—before, during and after surgery—will improve outcomes, decrease readmissions, earn CMS incentive payments and avoid penalties.