The CCJR requires approximately 800 hospitals in 67 areas across the country to participate in bundle payments for knee and hip replacement (DRG 469 and 470). The program will begin on April 1, 2016, according to the release.
The main points of the program according to the post include:
- Initially, it’s good to be expensive. CMS will set the initial spending target for your hospital based on your previous experience with CMS. If your organization has been getting sub-optimal results, your spending target in year one may be higher than your peers.
- This is a retrospective bundle. During the year all payments will be made as usual. But at the end of the year your total spend per episode will be compared with the target spend per episode set by CMS.
- Final targets set by competition. Over the course of this five year initiative, your target will shift from being based on your past performance to be being based on the average performance of providers in your MSA.
- Gainsharing is encouraged. CCJR allows providers to share up to 50 percent of the reward or penalty that comes from CMS. This is meant as a way of garnering greater cooperation with your partners; be they physicians, SNFs, or another group.
To read the post in full and learn about how to prepare for CCJR, click here.
