After attending many orthopedic conferences and forums this past year, I realized there are many misconceptions about the Comprehensive Care for Joint Replacement (CJR) model, bundled payments, and CMS's additional new payment models.
In the first year of CJR, many hospitals have been slow to take steps towards implementation of effective bundled payment strategies since there is no downside risk in the first year. Many believe their internal resources are sufficient to implement care redesign for lower joint surgery. Other hospitals are choosing to do nothing at all with the thought that higher costs in 2016 will increase their target price in the long run. I can tell you from experience that all of these notions are misguided. There is a lot to learn and hospital executives can get a head of the value based payment game by learning as much information as they can about CJR.
Questions that hospitals executives are asking themselves: Is my hospital prepared for CJR? How much money are we at risk to lose or gain? How can we maximize our savings in CJR? All good questions that we have the answers to.
As the largest convener of orthopedic physician groups in BPCI, Signature Medical Group, Inc. (SMG) has learned all of the necessary components for success in orthopedic bundled payments. We have been managing orthopedic bundled payments since 2014, managing over 45,000 annual Medicare joint replacement episodes performed by nearly 2,000 orthopedic surgeons from 56 physician group practices distributed across all regions of the country. Providers implementing our operational model have reduced episodic costs by 15–50%, reduced readmissions by 14%, and reduced overutilization of services by 15–65%. We have learned the strategies to succeed in bundled payments and are a leader in bundle payment management.
We have experienced firsthand the improved patient quality and substantial cost savings that have resulted from our operational model for orthopedic bundled payments. We have already shared strategies for CJR success in how to prepare for CJR, effective RFP design, reasons to gainshare, navigating claims data analytics, and more. We want to share even more of our information and knowledge so hospitals and physician groups can maximize their success in CJR. Our Signature Medical Group bundled payment team is hosting a CJR conference on October 25-26, 2016 to more comprehensively share our best practices in value-based payment initiatives. We have the experience, expertise, and proven results to provide the structure and tools necessary for success in CJR. Join us to learn more about our key CJR strategies.
Key strategies for CJR and bundled payment success:
• Identification of high-value strategic decisions to guide operational design
• Maximizing financial opportunity
• Physician engagement and alignment
• Program management
• Clinical coordination
• Standardization of care pathways
• Analysis of key metrics to maximize insights and financial gains
• Construction and management of an effective network of PAC services
• Reduction of PAC service overutilization
We look forward to seeing you there!
Follow me on Twitter @jimgera, connect with me on LinkedIn, or contact me at SMGBundles@signaturehealth.net for more information or assistance in implementing the CJR model.
— by Jim Gera, SVP of Business Development, Signature Medical Group, Inc.
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